(1098) Rendezvous with Death: Preparing Future Pharmacists for Death and Dying Experiences

Objectives: Pharmacists will encounter end-of-life care (EOLC) in a variety of settings. There is a growing need for EOLC training for pharmacists due to a growing elderly population; however, there has been a deficiency in pharmacist EOLC training.
To determine opportunities for improvement, an internal analysis of Cedarville University School of Pharmacy (CUSoP) faculty, students, and alumni was conducted to assess perceptions of student preparedness for EOLC. Results indicated that while individuals felt competent in managing EOLC for themselves, they perceived a deficiency in their ability to support and provide resources for other healthcare providers and families. Concern was expressed that students are not prepared to face EOLC in practice based on traditional lecturing alone. Based on these results, an educational intervention for third-year student pharmacists was developed. Therefore, the objectives were to (1) assess if an educational intervention can improve student pharmacist preparedness to face EOLC, and (2) to assess students’ perceived ability to provide support to patients and families in EOLC.

Methods: Third-year pharmacy students (N=33) enrolled in a required Advanced Bioethics course participated in a class session that was developed by the research team. The intervention was focused on providing pharmacist perspectives on death and dying in practice and applying practical communication tools to a patient case. The class session consisted of two sections: a pharmacist panel and a branched narrative application activity.
Three practicing pharmacists from CUSoP participated in a 40 minute panel discussion using questions prepared by the investigators. Participants were then invited to submit additional questions anonymously during the session via an online survey platform.
Following the panel discussion, participants were divided into groups of 5 to 6 students to work through a branched narrative that explored a realistic death and dying scenario. Each group discussed the prompts provided and collectively made selections to advance through the narrative. The research team discussed branched narrative pathways and the resources available to pharmacists in EOLC situations.
Pre- and post-surveys were used to collect demographic information and responses to a modified Lazenby’s End of Life Care Survey. Surveys were de-identified and entered into Microsoft Excel. Analyses were performed in SPSS 29.0.1. Alpha was set to 0.05 for statistical significance. Demographic items were analyzed using descriptive statistics. The data was analyzed for normality with the Shapiro-Wilk and Kolmogorov-Smirnov tests. The pre-post data was analyzed for differences with the Wilcoxon sign-rank test.

Results: Out of the 25 pre/post survey questions, 13 were statistically significant (p < 0.05). Following the intervention, students felt more comfortable dealing with ethical issues related to EOLC (p=0.002), being present with dying patients (p=0.008), and assisting family members and coworkers through the grieving process (p=0.005). In addition, students felt more familiar with hospice services (p=0.005), providing grief counseling (p=0.004), and maintaining continuity across the healthcare team (p=0.012).
There were no significant changes in students’ responses to items related to palliative care principles and national guidelines (p=0.227), recognizing impending death (p=0.158), and comfort dealing with patients’ and families’ religious and cultural perspectives (p=0.305).

Conclusions: The panel and branched narrative is a successful intervention to incorporate some topics of death and dying into a school of pharmacy curriculum. While this educational intervention can introduce students to death and dying concepts, some EOLC experiences may be better understood in experiential settings. Pharmacy preceptors might consider employing an interactive branched narrative to facilitate discussions about EOLC topics with students who have limited experience with death and dying scenarios.