Design, Implementation, and Outcomes of an Interprofessional Mobile Web Application for Preceptors for Challenging Issues.

Objective: The purpose of this study was to develop and assess an easily accessible interprofessional mobile web application to assist preceptors with challenging teaching and learning situations.

Methods: Phase 1 was a modified Delphi process of 48 advanced practice nursing, dentistry, medicine, and pharmacy preceptors to determine the content of the application. Phase 2 consisted of 12 preceptors from the 4 disciplines piloting a prototype to refine the tool using design-thinking principles.

Teaching colleagues how to discuss prognosis as part of a hospital-wide quality improvement project: the positive impact of a 90-minute workshop.

Background: Many physicians have difficulty with discussions about prognosis. The aims of this study were to evaluate why physicians struggle to discuss prognosis and to measure the effect of a 90-minute communication workshop on self-reported skill.

Measures: An evaluation study was used with three measurement points: before the 90-minute communication workshop (e-mail survey); immediately after the workshop (paper survey); and one month after the workshop (e-mail survey).

Improving access to palliative care through an innovative quality improvement initiative: an opportunity for pay-for-performance.

Background: Improving access to palliative care is an important priority for hospitals as they strive to provide the best care and quality of life for their patients. Even in hospitals with longstanding palliative care programs, only a small proportion of patients with life-threatening illnesses receive palliative care services. Our two well-established palliative care programs in large academic hospitals used an innovative quality improvement initiative to broaden access to palliative care services, particularly to noncancer patients.

Is pacemaker deactivation at the end of life unique? A case study and ethical analysis.

Although there has been considerable controversy regarding the deactivation of pacemakers near the end of life, clinicians can expect to face more requests for pacemaker withdrawal as the number of implants grows. Despite a clear ethical and legal precedent, these requests may elicit significant psychological and moral distress on the part of the clinical team. We illustrate some of the difficulties clinicians may face by describing the case of a patient with end-stage heart failure who asked to have her pacemaker turned off near the end of life.