Grief Training in Palliative Care Fellowships

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Grief and bereavement is an important part of palliative care. A recent study conducted by Barlow (2024) and colleagues attempted to determine the extent and the quality of grief and bereavement curricula in physician Hospice and Palliative Medicine (HPM) fellowship programs. This research is the first assessment of its kind, dedicated to shed light on the poorly studied area.

In order to complete the research, a survey of 14 different items was designed and distributed among Program Directors of Accreditation Council for Graduate Medical Education (ACGME) – accredited HPM fellowship programs in the United States. The survey was designed to obtain details on the program demographics, the curricula that are currently in place, the amount of grief and bereavement training and finally, the attitude of the program directors towards this type of training for the fellows.

The study revealed many important factors of the landscape of the grief and bereavement curriculum within HPM fellowship programs. Firstly, it was discovered that the majority of palliative care programs are affiliated with academic institutions and consisted of 74% of all fellows. It was also observed that most of the programs available (85%), had four or less fellows which demonstrates the smaller size of these programs.

One of the most impressive findings from the study was the short time in the curriculum that was concentrated on teaching grief and bereavement training within the HPM fellowship programs. Surprisingly, 90% of the programs dedicated only around 0%-10% of class time to grief and bereavement training. This finding underscores a potential gap in the in-depth training provided to the fellows, considering the significant amount of grief and bereavement they will encounter throughout their career.

Despite the limited curriculum time, the study demonstrated that a great number of programs, approximately 69%, reported offering some type of grief and bereavement programming. However, not all fellows were involved in these types of activities in more than half the programs examined. The results indicated that 53% of fellows were not involved at all or barely involved in these activities. This raises some questions on the effectiveness of the programs when considering if they are adequate in preparing HPM fellows to address grief during their careers.

Furthermore, the study highlighted a lack in certain areas such as providing support to families after a loss, demonstrating that only 49% of the programs dedicated class time to this crucial aspect of care. However, most programs, 55%, noted that they offered resources for debriefing or supporting the fellows through the grief they may feel. These included debriefing sessions and access to mental health resources.

In conclusion, the study demonstrates the importance of providing grief and bereavement training to Hospice and Palliative Medicine fellows. It highlights the major variations in the provision across programs and suggests that a standardized approach could be beneficial in order to ensure that the fellows are well prepared for what awaits them. Addressing these gaps could help to improve the quality of palliative care delivery and improve the outcomes for the patients and the families during end-of-life care.

Source: Barlow, S. A., Price, M., Jones, C. A., Pieper, C., & Galanos, A. N. (2024). Grief Training in Palliative Care FellowshipsJournal of Pain and Symptom Management.

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