The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and acceptance of a diversity of faith expressions.
The purpose of this paper is to complete a comparative ethical analysis of George’s situation and decision from the perspective of two worldviews or religions: Christianity and a second religion of your choosing. For the second faith, choose a faith that is unfamiliar to you. Examples of faiths to choose from include Sikh, Baha’i, Buddhism, Shintoism, etc.
In your comparative analysis, address all of the worldview questions in detail for Christianity and your selected faith. Refer to Chapter 2 of Called to Care for the list of questions. Once you have outlined the worldview of each religion, begin your ethical analysis from each perspective.
In a minimum of 1,500-2,000 words, provide an ethical analysis based upon the different belief systems, reinforcing major themes with insights gained from your research, and answering the following questions based on the research:
How would each religion interpret the nature of George’s malady and suffering? Is there a “why” to his disease and suffering? (i.e., is there a reason for why George is ill, beyond the reality of physical malady?)In George’s analysis of his own life, how would each religion think about the value of his life as a person, and value of his life with ALS?What sorts of values and considerations would each religion focus on in deliberating about whether or not George should opt for euthanasia?Given the above, what options would be morally justified under each religion for George and why?Finally, present and defend your own view.Support your position by referencing at least three academic resources in addition to the course readings, lectures, the Bible, and the textbooks for each religion. Each religion must have a primary source included. A total of six references are required according to the specifications listed above. Incorporate the research into your writing in an appropriate, scholarly manner.
Prepare this assignment according to the guidelines found in the APA Style Guide,
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
RUBRIC
1 Unsatisfactory 0.00%
2 Less Than Satisfactory 65.00%
3 Satisfactory 75.00%
4 Good 85.00%
5 Excellent 100.00%
70.0 %Content
20.0 %Identification of Ethical Issues as They Relate to the Four Principles of Principlism
The ethical issues are incorrectly organized.
Ethical issues are adequately organized according to the four principles of principlism. Some of the categorization is suspect.
Ethical issues are organized according to the four principles of principlism.
Ethical issues are organized according to the four principles of principlism. A distinction between the four principles is clearly stated, but the reasoning of the categorization is merely adequate.
Ethical issues are organized according to the four principles of principlism. A distinction between the four principles and the reasoning of the categorization is clearly stated.
20.0 %Description of the Christian Worldview and the Other Worldview
The description of the Christian worldview and the selected worldview address little to none of the seven worldview questions and the description is mostly incorrect or irrelevant.
The description of the Christian worldview and the selected worldview address most of the seven worldview questions with little evidence of a surface-level understanding.
The description of the Christian worldview and the selected worldview adequately address all seven worldview questions, but the description has a surface-level understanding.
The description of the Christian worldview and the selected worldview address all seven worldview questions with evidence of basic understanding utilizing a detailed description.
The description of the Christian worldview and the selected worldview address all seven worldview questions with evidence of a deep understanding utilizing a detailed description.
20.0 %Analysis of Ethical Issues through Christian Worldview and the Other Worldview
The primary principles and values in the decision making process of each worldview have little to no relevance. Ethical reasoning seems to have no connection from the worldview considerations.
The primary principles and values are acknowledged in the decision making process of each worldview. Ethical reasoning is loosely based from the worldview considerations.
The primary principles and values surface in the decision making process of each worldview. Ethical reasoning is implied from the worldview considerations.
The primary principles and values are recognized in the decision making process of each worldview. Ethical reasoning is explained from the worldview considerations. Most implications of the principles and values are given consideration.
The primary principles and values are clearly distinguished in the decision making process of each worldview. Ethical reasoning is clearly delineated from the worldview considerations. The implications of the principles and values are given complete consideration.
10.0 %Personal Recommendation
The personal recommendation from the student’s worldview is stated, but the justification has little to no relevance.
The personal recommendation from the student’s worldview is stated with proper justification.
The personal recommendation from the student’s worldview is stated with proper justification with some implications explained.
The personal recommendation from the student’s worldview is stated with proper justification. The primary principles of the student’s worldview are clearly described with most implications explained.
The personal recommendation from the student’s worldview is stated with proper justification. The primary principles of the student’s worldview are clearly described with all implications explained.
20.0 %Organization and Effectiveness
7.0 %Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.
Thesis and/or main claim are apparent and appropriate to purpose.
Thesis and/or main claim are clear and forecast the development of the paper. They are descriptive and reflective of the arguments and appropriate to the purpose.
Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
8.0 %Argument Logic and Construction
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.
Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) and/or word choice are present. Sentence structure is correct but not varied.
Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.
Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.
Writer is clearly in command of standard, written, academic English.
10.0 %Format
5.0 %Paper Format (use of appropriate style for the major and assignment)
Template is not used appropriately or documentation format is rarely followed correctly.
Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.
Appropriate template is used. Formatting is correct, although some minor errors may be present.
Appropriate template is fully used. There are virtually no errors in formatting style.
All format elements are correct.
5.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
Sources are not documented.
Documentation of sources is inconsistent and/or incorrect, as appropriate to assignment and style, with numerous formatting errors.
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
100 %Total Weightage
Chapter 2 called to care list of questions:
Seven Basic Worldview Questions James Sire defines a worldview as “a commitment, a fundamental orientation of the heart, that can be expressed as a story or in a set of presuppositions (assumptions which may be true, partially true or entirely false) which we hold (consciously or subconsciously, consistently or inconsistently) about the basic constitution of reality, and that provides the foundation on which we live and move and have our being.”* He asserts that to understand the concept of worldview, we must answer the following questions:
•What is prime reality? •What is the nature of the world around us?•What is a human being?•What happens to a person at death?•Why is it possible to know anything at all?•How do we know what is right and wrong?•What is the meaning of human history?**
For the Christian nurse, the answers to these questions come from the stories, themes and patterns found in the Bible. This careful study of Scripture reveals to us the nature of persons, the context in which we live and practice, the meaning of health and the impetus for nursing care. For Christians, prime reality is God, who created and sustains all things. Thus, this worldview is derived from a Christian theology of nursing.Clinical Journal of Oncology Nursing • Volume 19, Number 6 • Skills Training for Discussing End-of-Life Care 697
Nessa Coyle, PhD, APRN, FAAN, Ruth Manna, MPH, Megan Johnson Shen, PhD, Smita C. Banerjee, PhD, Stacey Penn, BSN, RN, OCN®, Cassandra Pehrson, MSW, Carol A. Krueger, MS, LCSW, Erin K. Maloney, PhD, Talia Zaider, PhD, and Carma L. Bylund, PhD
n Article
Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses
D espite nurses’ centrality in the process of the healthcare team communicating with patients, few receive formal education specific to communica- tion, particularly related to end-of-life care (Chant, Jenkinson, Randle, & Russell, 2002; Kruijver, Kerk-
stra, Bensing, & van de Wiel, 2000; Vydelingum, 2006). How- ever, nurses rank communication as one of the most important competencies to their practice (McCabe, 2004; McGilton, Irwin-Robinson, Boscart, & Spanjevic, 2006). Although nurses
generally feel confident in providing care for the physical needs of patients with cancer, they find addressing the patients’ emo- tional concerns to be more difficult (Rask, Jensen, Andersen, & Zachariae, 2009). These reported difficulties in communication exist among hospice nurses as well (Ellington et al., 2008; El- lington, Reblin, Clayton, Berry, & Mooney, 2012).
Nurses’ communication skills are crucial to patient care because they provide much of the care and support to patients and their families throughout the disease trajectory. Nurses
Background: Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. Objectives: The aim of this article is to adapt an end-of-life care communication skills train- ing (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants’ confidence in using the communication skills learned and their satisfaction with the module.
Methods: The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. Findings: Nurses’ confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%–98% of the time. Nurses’ CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.
Nessa Coyle, PhD, APRN, FAAN, is a consultant, Ruth Manna, MPH, is the manager of the Comskil Program, Megan Johnson Shen, PhD, is a postdoctoral research fellow, Smita C. Banerjee, PhD, is an assistant attending behavioral scientist, Stacey Penn, BSN, RN, OCN®, is a clinical nurse, Cassandra Pehrson, MSW, is a training assistant for the Comskil Program, and Carol A. Krueger, MS, LCSW, is a patient representative, all at Memorial Sloan Kettering Cancer Center in New York, NY; Erin K. Maloney, PhD, is the research director for the Tobacco Center of Regulatory Science at the University of Pennsylvania in Philadelphia; Talia Zaider, PhD, is an assistant attending psychologist at Memorial Sloan Kettering Cancer Center; and Carma L. Bylund, PhD, is the associate director of medical education at the Hamad Medical Corporation in Doha, Qatar. The authors take full responsibility for the content of the article. The study was supported, in part, by funding from the Geri and ME Fund, Memorial Sloan Kettering Nursing Education, the Fridolin Charitable Trust, and a grant (T32-CA009461) from the National Cancer Institute. The content of the article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of the article have been disclosed by the independent peer reviewers or editorial staff. Coyle can be reached at [email protected], with copy to editor at [email protected]. (Submitted January 2015. Revision submitted April 2015. Accepted for publication April 6, 2015.)
Key words: death; dying; end-of-life care; nurse–patient communication; transitions in goals of care; communication skills; training
Digital Object Identifier: 10.1188/15.CJON.697-702
© Susan Chiang/iStock
698 December 2015 • Volume 19, Number 6 • Clinical Journal of Oncology Nursing
are also more likely to be present at the time of death than any other healthcare professional (Wiegand & Russo, 2013). In ac- knowledgment of this reality, the Institute of Medicine (2010) reported that, although physicians have traditionally been responsible for these difficult end-of-life conversations, nurses are taking the lead with the advancement of nursing practice.
Key to improving nurses’ involvement in patients’ end-of- life care is training them how to communicate these issues to patients and their families. According to the American Nurses Association (2010), nurses have several responsibilities in car- ing for dying patients, including discussing life preferences and communicating relevant information. Because communication has been shown to be a cornerstone of improving patients’ qual- ity of care and quality of life (Wittenberg-Lyles, Goldsmith, Fer- rell, & Ragan, 2013), the Na
tional Consensus Project for Quality Palliative Care (2013) has emphasized the need for effective, compassionate communication in palliative care.
Nurses have reported that merely learning communication skills on the job is not enough (Humphris, 2002), suggesting the need for formalized training. To address this need, a variety of interventions to improve nurses’ communication skills and effi- cacy has been developed. The majority of communication skills training (CST) has been effective at increasing nurses’ abilities to provide psychosocial support to patients, their confidence in handling conflicts and criticism, and communication-related self-efficacy (Langewitz et al., 2010; Sheldon, 2011; van Weert, Jansen, Spreeuwenberg, van Dulmen, & Bensing, 2011; Wilkin- son, Linsell, Perry, & Blanchard, 2008). Most CST developed for nurses has focused on general communication, with partici- pants focusing on how to have difficult conversations and break bad news (Baer & Weinstein, 2013). Because of the prevalence of nurses present at the end of life (Wiegand & Russo, 2013) and their increased involvement in end-of-life care discussions (In- stitute of Medicine, 2010), developing CST modules for nurses that specifically target end-of-life care discussions is critical.
To address this key need, the researchers adapted and modi- fied a physician end-of-life care module for oncology nurses that already had been developed and evaluated by the researchers’ institution. In this adapted CST module, the researchers were able to incorporate the communication differences inherent in the nurse–patient relationship and the communication skills necessary to that relationship. The primary aim of this article is to discuss the content and adaptation of the CST module. The secondary aim of this article is to evaluate the module by report- ing the results on pilot self-report data on nurses’ confidence in discussing death and dying, their intention to use the skills they learned in training, and their overall satisfaction with the module.
Methods The CST and Research Laboratory, housed in the Department
of Psychiatry and Behavioral Sciences at Memorial Sloan Ket- tering Cancer Center (MSKCC) in New York, originally devel- oped a series of modules for physicians, which are described elsewhere (Bialer, Kissane, Brown, Levin, & Bylund, 2011; Brown, Bylund, Eddington, Gueguen, & Kissane, 2010). This curriculum has been shown to lead to improvements in the use of major communication skill sets in clinical settings (Bylund
et al., 2010). Based on nursing engagement surveys at MSKCC indicating a need and demand for training oncology nurses in communication skills, the researchers adapted this curriculum to fit the needs of nurses. The researchers’ laboratory created a multidisciplinary development committee including nursing experts in oncology nursing and end-of-life care. This article describes one of the modules that was adapted for the nursing CST, namely the “Discussing Death, Dying, and End-of-Life Goals of Care” module.
Framework
The training modules developed in the researchers’ laboratory are based on the Comskil Conceptual Model (Brown & Bylund, 2008), which describes clinical consultation communication as being composed of goals, strategies, skills, and process tasks. A communication goal is the desired outcome of a consultation or interaction. Goals are obtained through strategies, which are a priori plans that direct communication behavior toward the desired communication goal. Strategies are achieved using communication skills, which are defined as discrete, measurable units of speech in which a clinician can further the clinical dia- logue. Process tasks are sets of dialogue or nonverbal behaviors that create an environment for effective communication. Each of these components are put in a modular blueprint that details how these components work together for addressing specific topics within a clinical consultation or interaction (see Table 1).
The adaptation of the Discussing Death, Dying, and End-of- Life Goals of Care module for nurses included a series of seven steps used in the researchers’ prior work (Brown, Bylund, Gueguen, et al., 2010). These seven consecutive steps included (a) systematic literature review, (b) consensus review meetings (with researchers, communication skill experts, and nurses), (c) modular blueprint development, (d) training methods develop- ment, (e) scenario development (for role plays and exemplary video clips), (f) making necessary revisions and adaptations, and (g) assessment of the training module (Brown, Bylund, Eddington, et al., 2010).
Participants
From 2012–2014, 247 inpatient nurses working in the oncol- ogy setting at MSKCC participated in this CST module. Inpatient nurse specialties included acute care (n = 169, 68%), pediatrics (n = 39, 16%), critical care (n = 25, 10%), and urgent care (n = 14, 6%). Nurses were selected for this CST by their nurse lead- ers, with a focus on bedside and clinic nurses. On average, 12 nurses participated in the CST per session to allow all partici- pants to practice during the small group interaction and role play. Nurses who participated in this module also participated in two other modules to complete a day-long curriculum. These additional modules were titled “Responding Empathically to Patients” and “Responding to Challenging Interactions With Families.” Each module lasted about two hours. An institutional review board waiver was approved to allow the researchers’ laboratory to operate this training as a quality improvement initiative to the nursing CST curriculum. The exempt status allowed the laboratory to conduct CST training as a routine educational practice and permitted release of deidentified data on the effectiveness of this training program.
Clinical Journal of Oncology Nursing • Volume 19, Number 6 • Skills Training for Discussing End-of-Life Care 699
Modular Content
The overall communication goal for oncology nurses when discussing death, dying, and end-of-life goals of care is to sup- port patients and their family members during these discus- sions and to aid in decision-making processes regarding transi- tions in goals of care. The previous model for the physician’s module focused on clinical information regarding the progno- sis of the patients as well as reaching a shared understanding about their wishes at end of life. This module suggests five strategies, along with appropriate communication skills and process tasks, which allow nurses to achieve this desired goal of patient interaction across a number of patient and family interactions.
Strategies 1 and 2 involve establishing a relationship with the patients and developing an accurate, shared understanding of their situation. Endorsing question asking can address concerns or confusion the patient may have, allowing a shared under- standing to be reached. Checking the patients’ or their family’s understanding of the situation further enables the nurse to correct misunderstandings and increase shared understanding. Questioning skills, such as clarifying, also can help deepen the shared understanding of the patients’ situation and its implica- tions. Inviting patients’ or their family members’ agenda items into the discussion is also an important communication skill that allows patients’ and their family members’ concerns to be addressed.
Most commonly, bedside nurses are responsible for support- ing patients and their family members after having an end-of-life
discussion with their physician or advanced practitioner nurse (APN). Strategy 3 focuses on specific communication skills and process tasks that can be used to support the patients and their family members following the physician’s or APN’s discussion on transitioning from curative therapy to end-of-life care. Tak- ing stock of how the patient is feeling and asking open-ended questions (e.g., “What’s going through your mind?”) allows patients to tell the story in their own words and to express any concerns, confusion, or distress that they may be experiencing. These open-ended questions should be followed up by checking their understanding and endorsing further question asking to correct any remaining misunderstandings. Questioning skills (e.g., clarifying, restating), can be used to continue to deepen the shared understanding of their situation and emotional state. Sensitivity to patients’ emotional responses is an integral part of these conversations.
Strategy 4 represents the core communication skill of re- sponding empathically to patients’ emotions. In this strategy, the use of supportive skills (e.g., acknowledging, validating, normalizing patients’ emotions) is a practical way to help them feel understood and supported. Acknowledging patients’ emo- tions (e.g., “I can see how overwhelmed you are.”) is simply stating the emotion that the nurse observes. Validating patients’ emotions (e.g., “This must be so hard.”) goes a step further than acknowledging by indicating that the patient has a right to feel this way. Normalizing (e.g., “Most people in your situation feel the same way.”) indicates that their emotions are commonly experienced by others in similar situations. Finally, praising patients’ efforts (e.g., “I am so impressed by how you have
TABLE 1. Modular Blueprint for Discussing Death, Dying, and End-of-Life Goals of Care
Strategy Skills Process Tasks
Establish the relationship. • Endorse question asking. • Check patient and family understanding. • Invite patient and family agenda items.
• Ensure privacy and comfort. • Make partnership statements.
Develop an accurate, shared understanding of the patient’s situation, including disease features, prognosis without treatment, and psychosocial needs and concerns.
• Check patient and family understanding. • Clarify. • Check patient preference information.
• Discuss expectations. • Correct misunderstandings.
Support patients and their family following the physician’s discussion of death and dy- ing and end-of-life goals.
• Take stock. • Ask open questions. • Check patient understanding. • Endorse question asking. • Clarify. • Restate.
• Tailor to the patient’s preferences for level of detail. • Ask if a discussion of the dying process would be helpful. • Describe the natural dying process. • Avoid jargon and euphemisms. • Consider spiritual or religious needs. • Address specific cultural needs.
Respond empathically to patient’s emo- tional response.
• Ask open questions. • Encourage expression of feelings. • Acknowledge. • Validate. • Normalize. • Praise patient efforts.
• Allow time to integrate and allow for silence. • Offer tissues. • Touch, when appropriate.
Close the conversation. • Take stock. • Summarize. • Check patient understanding. • Make partnership statements.
• Emphasize the quality of symptom control and goals of care—a peaceful, natural death.
• Affirm courage. • Remind about team availability.
Note. The goal is to support patients and their family members during discussions and the decision-making process regarding end-of-life care.
700 December 2015 • Volume 19, Number 6 • Clinical Journal of Oncology Nursing
dealt with your illness.”) helps to solidify the nurse–patient partnership. When responding to patients’ emotions, nurses should allow for times of silence so that patients can process their emotions. When appropriate, physical touch (e.g., a hand on the arm) may help communicate that the nurse is responsive to their emotions.
Strategy 5 closes the conversation with acknowledging that a lot of information has been covered, acknowledging that patients and their family members may be overwhelmed, and reassuring them that the conversation will be continued in the future. As the conversation draws to a close, the nurse again should take stock of their understanding. The focus during these conversations is on things of importance to the patient as his or her life draws to a close. Although not all interactions with patients about transitions in goals of care to quality of life at the end of life can be touched on, each of these strategies and skills can be used across several conversations to help guide patients and their family members throughout the transition to end-of-life care.
Training Agenda and Process
Prior to attending the day-long CST, participants were asked
to review three workbooks, one designed for each module.
These workbooks served as preparation for the workshop
and as a resource for trainees after participation in training.
The workbook for the present module included supporting
literature and educational materials on effective ways to discuss
death, dying, and end-of-life goals of care, as well as frequently
asked questions on this topic.
At the beginning of this module, a nursing expert on end-
of-life care gave a 45-minute didactic slide presentation sum-
marizing the evidence-based literature on end-of-life care.
After this brief summary, the presentation focused on specific
strategies, communication skills, and process tasks that could
be used to accomplish the communication goals of support-
ing patients and their family members during discussions and
aiding patients and their family members in decision-making
processes regarding end-of-life care. Each strategy slide in the
didactic presentation included a 2–3-minute video clip of a
nurse demonstrating how the communication skills relevant to
that strategy could be helpful in a conversation. The name of the
specific communication skill being used was clearly displayed
at the bottom of the video during the recorded interaction to
reinforce the use of each skill presented.
Prior CST research shows that to improve communication
skills, training must be participatory and experiential (Parry,
2008). Therefore, following the didactic presentation, nurses
participated in an experiential role play in small groups (2–3
nurses) to practice the skills and strategies introduced in the
didactic presentation. Two trained facilitators—a nurse paired
with a communication specialist—led these small-group role-
play sessions. Facilitator training consisted of a three-hour
training described elsewhere (Bylund et al., 2008). Prepared
role-play scenarios were used to give nurses the opportunity to
practice their communication strategies and skills with trained
actors who simulated patients. Each scenario depicted a scene
in which a physician had just discussed transition to end-of-life
goals of care and the nurse stayed with the patient to respond
to the patient’s emotions and clarify what had been commu- nicated.
Each role-play session lasted about 90 minutes, and the time was divided equally among the 2–3 nurses. Prior to role play, the rules of confidentiality were outlined, anxiety on the part of the nurses was normalized, and the ability to take “time outs” was explained. At the start of role play, learners identified their learning goal for the standardized patient interaction and which communication skills they wanted to practice. During the scenarios, nurses had the opportunity to practice these communication skills. Following role play, nurses first were asked to reflect on their use of communication skills, name any communication skills used, and indicate whether they had met their learning goals. Next, they were given feedback from their peers, the facilitators, video playback, and, at the end of session, the actor in the role of the patient. This workshop followed best practice principles in adult learning of being learner-centered and experiential and involving individualized, targeted feed- back (Knowles, 1978).
Evaluation
At the end of the module, participants were given an evalu- ation form to complete anonymously. It included eight state- ments about the workshop using five-point Likert-type scales assessing participants’ levels of agreement or disagreement with each statement (1 = “strongly disagree” and 5 = “strongly agree”). In addition, a retrospective pre–post method (Hill & Betz, 2005) was used in the first two statements: (a) “Before this module, I felt confident discussing death, dying, and end-of-life goals of care,” and (b) “Now that I have attended this module, I feel confident discussing death, dying, and end-of-life goals of care.” The remaining items asse