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1. Participants will self-report an enhanced ability to describe preclinical medical and dental students' reactions to early observed encounters with seriously ill and dying patients. 2. Participants will self-report the ability to appraise and apply interprofessional approaches to supporting student wellness in the context of early clinical exposure. Preclinical medical and dental student responses to early observed clinical encounters with seriously ill and dying patients reveal opportunities for faculty to support student wellness. Interprofessional HPM clinician-educators utilize approaches involving validating, educating, and empowering learners following early experiences. Lessons learned from these approaches can inform faculty development around the lived student experience and strategies for proactively supporting student wellness. Previous work highlights the value of preclinical medical student exposure to the practice of hospice and palliative medicine (HPM) and indicates that students may experience strong or unanticipated emotion in early encounters with seriously ill or dying patients. To explore the nature of students' processing of early interactions with seriously ill patients and their families, as well as opportunities for HPM clinician-educators to support student wellness in the context of these experiences. In 2023, 167 first-year medical and dental students at a large urban medical school were assigned a written reflection following a half-day faculty-mentored HPM shadowing experience and debriefing session. An HPM clinician-educator (physician, nurse, social worker, or chaplain) provided a written response to each reflection. Qualitative analysis was utilized to identify themes arising from both student reflections and clinician-educator responses. 150/167 students (90%) submitted reflections; 150/150 reflections (100%) were provided written responses by an HPM clinician-educator. Three primary student content themes were revealed: 1) strong emotions related to witnessing difficult circumstances (e.g., uncontrolled symptoms; imminently dying patients; personally resonant situations), 2) acquisition of new HPM knowledge (e.g., palliative care is not reserved only for end of life), and 3) impact of the experience on anticipated future patient care (e.g., inspiration to build meaningful connections with patients). Primary faculty response themes included: 1) validation of emotion/strategies for self-care, 2) reinforcement of/expanded detail on HPM principles, and 3) sharing personal insights and opportunities for continued professional development. Students' written reflections suggest common themes in processing observations of clinical encounters with seriously ill and dying patients. HPM clinician-educators across professions shared an approach to supporting student wellness that involved validating, educating, and empowering. Lessons learned could inform faculty development around the lived student experience and opportunities to proactively support student wellness. Resilience / Well being / Interdisciplinary Teamwork / Professionalism [ABSTRACT FROM AUTHOR]

When caring for a grieving patient, professional chaplains may assess the patient's spiritual suffering, address questions of meaning and purpose, and identify sources of comfort, love, and strength. In the setting of a pandemic, with heightened precautions and limited visitation by loved ones, all members of the clinical team are called to utilize compassionate listening and communication skills to address the pervasive isolation and grief of those in their care. This article uses a chaplain's personal narrative to explore the challenges of facilitating grief support with a newly bereaved patient who cannot speak. It presents the Biblical concept of kol d'mama daka, the "still small voice," as an image of the power of silence and revelation that comes when clinicians employ deep listening and compassion. [ABSTRACT FROM AUTHOR]

The article offers insights into how health care personnel could response to patients and families who are hoping for a miracle cure. Topics mentioned include the influence of spiritual beliefs and religious practices on decision making, the need for health care personnel to know the beliefs of their patients and agree with their hopes for a miracle, and the role of an expert clinical chaplain.

The Latinx population faced higher rates of infection and severe illness during the COVID-19 pandemic, resulting in an increased need for palliative care services. We describe the creation and impact of a formal palliative care initiative developed for seriously ill, Spanish-speaking patients during the COVID-19 pandemic at a tertiary care academic medical center. Patients were enrolled in the Spanish Palliative Care Initiative during a two-month period starting in April 2020. Selected patients were longitudinally followed by a rotating team of Spanish-speaking palliative care clinicians. Following the intervention, a retrospective chart review was conducted to evaluate the impact of the program. We enrolled 22 patients. The most frequent palliative care task completed during the initial visit was information giving (77%) and during follow-up visits were goals of care discussion (59%) and coping support (59%). Fifteen patients (68%) had a change in code status and 4 patients (18%) were discharged to hospice. The creation of a focused clinical program targeting a historically marginalized population offered opportunity for early palliative care intervention in clinical care for Spanish-speaking patients. This underscores the need for Spanish-language concordant palliative care to improve serious illness care, and end-of-life care, by providing continuity of care, spiritual care, and ICU team support. [ABSTRACT FROM AUTHOR]

Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter. [ABSTRACT FROM AUTHOR]

Among the many disruptive effects of a terminal cancer diagnosis in young people is its ability to affect reproductive planning and the opportunity for parenthood. While many reproductive-aged cancer patients receive fertility counseling at diagnosis, ongoing guidance often does not occur during the illness course and associated distress may go unrecognized. Using a case-based framework, this palliative care rounds explores the existential, spiritual, ethical, and logistical challenges that complicate reproductive planning for patients and families as they face a terminal cancer diagnosis. We advocate that palliative care providers should seize currently underrecognized opportunities to screen for distress associated with fertility and reproduction at end of life and utilize an interdisciplinary team approach to provide appropriate support and counseling throughout the illness and bereavement experience. [ABSTRACT FROM AUTHOR]

Establishing an empathic clinical relationship is a cornerstone of high-quality palliative care. More than simply approaching patients with a pleasant affect or "being nice," we propose that skilled clinicians routinely employ distinct psychological elements when creating effective bonds with seriously ill patients and their families. Palliative care involvement has been shown to improve a variety of outcomes for patients with serious cancer, and yet the components of this salutary effect are still becoming known in the literature. Many believe that a successful interpersonal relationship is the essential factor. In this article, we will apply the psychological constructs of transference and countertransference to the unique arena of palliative care communication. Although most palliative care clinicians are not mental health clinicians and have not received training or certification in psychotherapeutic techniques, there are elements from these frameworks that may be advantageously applied. We will draw on sources from psychology and psychiatry to explore the in-between spaces of clinical encounter. Using the case of Gloria, a patient living with cancer drawn from our clinical experience, we will offer adapted definitions and novel applications of these psychological concepts. Branching from the theory to everyday practice, we will then offer practical suggestions to guide the palliative care clinician in recognizing and managing strong countertransference reactions. This article is the third installment of a series on the psychological elements of palliative care. [ABSTRACT FROM AUTHOR]

COVID-19 strained our nation's hospitals and exposed gaps in care. As COVID-19 surged in Boston in March 2020, we worked to rapidly create a Palliative Care Compassion Unit (PCCU) to care for those dying of COVID-19 or non-COVID-19–related illnesses. The PCCU provided interdisciplinary end-of-life care, supported families, and enabled surge teams to focus on patients needing life-sustaining treatments. In this study, we describe the creation of the PCCU, including opportunities and challenges, in hopes of lending insight to other palliative care teams who may need to rapidly craft new care models during a crisis. [ABSTRACT FROM AUTHOR]