University of Arizona Launches End-of-Life Medical Training Program

As clinician shortages continue to plague the hospice space, the University of Arizona Health Sciences is expanding end-of-life medical education through its new Interprofessional End-of-Life Care Training Program. The program focuses on training students to incorporate a multicultural and interdisciplinary approach to end-of-life conversations with patients and their families.

Faculty at the University of Arizona Center on Aging collaborated with colleges and health care centers to develop a curriculum that will offer age, gender and culturally sensitive training to students. The interdisciplinary program will provide guidance to doctors, nurses, pharmacists and other professionals.

Medical personnel often lack adequate skills and training in end-of-life conversations, according to Mindy Fain, M.D., professor of medicine, associate professor of nursing, chief of the Division of Geriatrics, General Internal Medicine and Palliative Medicine and co-director of the University of Arizona Center on Aging.

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The university sent surveys to all students in its Health Sciences schools. Their responses indicated a significant need and interest in training for end-of-life and serious illness care, according to Fain.

“Uniformly, every Health Sciences student expressed the need and interest in getting this training,” said Fain in an announcement from the university. “There’s clearly a need for training our health professional students across the Health Sciences in serious illness and end-of-life care. We are excited about the possibility of bridging that gap.”

The program includes a serious illness and end-of-life care curriculum toolkit with cases that faculty can integrate into their existing courses. The curriculum is designed to help transform the culture around serious illness, death and dying, according to Fain.

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Most medical, nursing and social work students receive little exposure to hospice or palliative care during their training, complicating providers’ recruitment efforts. A 2018 study showed that most students in clinical disciplines do not feel prepared to provide family care at the end of life. This has been a key factor driving hospice and palliative care workforce shortages for the past several years.

The labor pressures have only been exacerbated by the global spread of a deadly virus. A recent study from the JAMA Network Open found that a little more than 20% of health care workers have considered leaving the field due to stress brought on by the pandemic, and 30% have considered reducing their hours.

Workforce shortages have contributed to the closure of some hospice programs during the pandemic.

Closing cultural and racial gaps in access and utilization of hospice care is another goal of the university’s program. More than 80% of Medicare hospice patients in 2018 were Caucasian, according to the National Hospice and Palliative Organization (NHPCO). African American, Asian, and Hispanic patients comprised less than 20%.

“Some of the information that we got back from faculty and other providers is they know the information is out there, but some of it is so general it’s hard for them to incorporate in their care,” said Lisa O’Neill, associate director at the Center on Aging. “We want to give students the skills to have those conversations with their specific patients.”

The program builds onto the university’s current medical and nursing curricula and complements other goals-of-care initiatives as part of the Arizona End-of-Life Care Partnership, a coalition of organizations led by the United Way of Tucson and Southern Arizona.

The new Health Sciences training program received a $500,000 grant from the David and Lura Lovell Foundation. The foundation previously financed the Center on Aging’s Living Will Project for the University of Arizona College of Medicine. That project includes a four-year medical students training program designed to build knowledge in end-of-life care.

Additionally, the foundation in 2019 financed an initiative from the Coalition to Transform Advanced Care (C-TAC) to measure and improve the quality of advanced illness care across the United States. The Advanced Care Transformation Index project’s first phase kicked off with an Arizona-based program that examined data on 37 quality measures. Collaborating organizations included the Arizona End-of-Life Care Partnership and the Arizona Hospital and Health Association. Taking a state-by-state approach, C-TAC uses the data to identify best practices from each region.

Educators hope that the new Health Sciences training program will help to “end the stigma and discomfort people experience when talking about end-of-life care,” according to John Amoroso, executive director at the Lovell Foundation.

“With this grant, the Lovell Foundation is trying to ensure that every University of Arizona Health Sciences student has a basic knowledge of how to talk about and provide compassionate end-of-life care for people,” said Amoroso. “This is a critical and, to date, [a] missing piece in realizing ‘person-centered, goal-concordant care’ across the spectrum of life’s health care choices made by Arizonans.”

Hospice utilization runs high among Medicare decedents in the Grand Canyon State, reaching 59.2% in 2019, according to the NHPCO. Arizona ranked second nationwide that year, with only Utah seeing a higher rate of hospice utilization at 59.4%.

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