The Role of Self-Reflection in Palliative Care Education: A Pilot Study of Students Attitudes and Perspectives on End-of-Life Care (740)

Objectives 1. Define palliative care doula. 2. List three positive outcomes of this innovative advance practice nursing model. 3. Articulate the purpose of this survey based study. Background. Nearly 2.5 million Americans die annually, 90% having experienced a life-limiting, progressively deteriorating illness requiring major healthcare decisions. A palliative care doula (PCD) is an innovative advanced practice model that provides detailed explanation of pathophysiologic changes associated with the disease process to patient and family members at various appropriate points along the continuum to ease the difficulty experienced in decision making. Case description. This retrospective survey based study measures the effectiveness of this model via proxy satisfaction. The PCD followed three end-stage cancer patients for 1-9 months (average: 5 months). Weekly visits were held with the patient and family throughout the remaining period of the patient’s life. Periodic phone calls and medical visits were made to keep the PCD informed regarding disease progression to anticipate foreseeable complications and remain proactive in discussing risks/burdens of same. With each visit, the PCD reviewed and clarified the explanations of medical information and provided ‘‘what if’’ inquiries encouraging open dialogue regarding future decisions. Conclusion. Nine proxy surveys were mailed to the surviving spouses and adult children yielding a 66% return rate (6/9). Three measures of satisfaction were collected with a Likert-type scale including: emotional support (mean 1⁄4 9; range 8-10), level of understanding about disease pathophysiology and what was happening with the proxy’s loved one’s disease progression (mean 1⁄4 9.8; range 9-10) and level of confidence felt in making decisions (mean 1⁄4 8.6; range 5-10). Level of satisfaction was scored using 5 descriptors from very satisfied to very dissatisfied with 100% response of ‘‘very satisfied’’ on the returned surveys. The PCD model has the potential to improve patient/family understanding of disease progression through guided advocacy and improve confidence in decision making while increasing emotional support for all involved. Future research is needed to explore the efficacy of this model on a larger scale.