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Training community volunteers and professionals in the psychosocial aspects of palliative care
Correspondence Address: DOI: 10.4103/0973-1075.16647 Keywords: volunteer training, palliative care, communication skills
Many palliative care patients have complex social, financial, and spiritual problems that doctors and nurses are not equipped to handle. The Neighbourhood Networks in Palliative Care train local volunteers in communication skills and the psychosocial aspects of care so that they can identify and address some of these concerns with the help of the community. This article discusses the programme of basic and advanced communication skills training conducted by the NNPCs.
People who are willing to spend at least two hours every week caring for chronically ill people are invited to attend the basic training module in small groups of ten to twenty. Approximately 500 volunteers undergo basic training each year. The training involves 16 hours of interactive classes and two days each of supervised placement in the outpatient clinic and home visits. During the basic training, six hours are spent on teaching communication skills. The sessions involve group work and role playing. The communication topics covered are: 1. What is communication? 2. The components of communication 3. The complexity of the communication process 4. Identifying one's own communication style 5. Difficulties in communicating with others 6. Basic communication skills 7. Effective communication 8. Truth telling 9. Psychosocial issues related to chronic and/or incurable diseases 10. Handling reactions to bad news The advanced programme provides twenty hours of communication skills teaching. The topics of the basic course are covered in greater detail, and issues such as denial, collusion, and depression are dealt with. In addition to group discussions and role plays, there are assignments and an end of course evaluation. This programme was started last year and has been completed by 50 volunteers, many of whom have gone on to train others in communication.
Trained volunteers are actively involved in planning and developing communication programmes. They meet every six months with the palliative care staff to evaluate and revise the communication modules. In addition, communication training teams of 2-4 persons meet before and after every training session in order to reflect on and plan for each session. The volunteers input, drawn from their experience in patient care and teaching, helps keep the course rooted in and relevant to the community. The advanced training module is now also used to teach doctors and nurses who take the six week course in palliative care as well as nursing students from different nursing schools. Medical students are given a compressed six hour module in communication skills. It is rewarding to see trained volunteers effectively and confidently participating in teaching health care professionals.
At present there is no screening or evaluation for volunteers who undergo the basic training, and although hundreds of volunteers have been trained, there is no formal system to evaluate the quality of psycho social support offered to patients. The results of these programmes run by palliative care doctors, nurses, and volunteers have not been compared with other methods of training. (Most health care courses in India do not include any communication skills training.) The limitations have to be understood in the context of the fact that this is a pioneering effort in a part of the developing world where there is no other mechanism for formal psycho-social support for chronically / incurably ill patients. The recent collaboration with the Institute of Mental Health and Neuro Sciences in Calicut, an academic institution in psychiatry, and the plans to develop a psycho-oncology centre in Trichur may help address some of the concerns about assessments and evaluations.
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