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. 2024 Jan 8;13(e3):e1008-e1018.
doi: 10.1136/bmjspcare-2021-003013.

Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content

Felicity Dewhurst  1   2 , Barbara Hanratty  3 , Katherine Frew  4 , Paul Paes  4   5 , Richard Walker  3   6 , Catherine Barnes  7 , Helena Maddock  8 , Joanna Elverson  2 , Lucie Byrne-Davis  9
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Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content

Felicity Dewhurst et al. BMJ Support Palliat Care. .

Abstract

Objectives: Frailty is common and highly associated with morbidity and mortality, a fact that has been highlighted by COVID-19. Understanding how to provide palliative care for frail individuals is an international priority, despite receiving limited mention in Palliative Medicine curricula or examinations worldwide. This study aimed to synthesise evidence and establish expert consensus on what should be included in a Palliative-Medicine Specialist Training Curriculum for frailty.

Methods: Literature Meta-synthesis conducted by palliative medicine, frailty and education experts produced a draft curriculum with Bologna based Learning-Outcomes. A Delphi study asked experts to rate the importance of Learning-Outcomes for specialist-training completion and propose additional Learning-Outcomes. This process was repeated until 70% consensus was achieved for over 90% of Learning-Outcomes. Experts divided Learning-Outcomes into specific (for inclusion in a frailty subsection) or generic (applicable to other palliative conditions). The Delphi panel was Subject Matter Experts: Palliative-Medicine Consultants (n=14) and Trainees (n=10), representing hospital, community, hospice and care home services and including committee members of key national training organisations. A final reviewing panel of Geriatric Medicine Specialists including experts in research methodology, national training requirements and frailty were selected.

Results: The meta-synthesis produced 114 Learning-Outcomes. The Delphi Study and Review by Geriatric Medicine experts resulted in 46 essential and 33 desirable Learning-Outcomes.

Conclusions: This frailty curriculum is applicable internationally and highlights the complex and unique palliative needs of frail patients. Future research is required to inform implementation, educational delivery and service provision.

Keywords: education and training; nursing home care; supportive care; symptoms and symptom management; terminal care.

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Conflict of interest statement

Competing interests: The authors have declared the receipt of the following financial support for this research: This work was completed as part of FD’s master’s in health Professions Education in association with Keele University and FAIMER. This was funded by Health Education England North East as part of the Specialty Training Programme.

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