A LION IN THE HOUSE Module for Health Care Education: Pediatric End-of-Life Case Studies
|8362||February 14, 2012||1|
Justin’s Story is part of Pediatric End-of-Life Case Studies, one of seven teaching modules drawn from the Emmy Award-winning documentary, A LION IN THE HOUSE (LION). LION portrays an unprecedented, intimate look at the realities of childhood cancer through the journeys of five families and their professional caregivers over the course of six years. Justin’s Story provides a forum for open-ended discussion and consideration of compassionate approaches for navigating pediatric end-of-life. It offers content that is unpredictable and not always best practice. Learners reflect on the complex impact of childhood cancer on Justin, his family and their professional caregivers. Justin’s Story is designed in consultation with top cancer organizations, leading professionals and medical educators to improve quality of teaching and learning, to enhance patient care, and fulfill competencies required by the Accreditation Council for Graduate Medical Education, among others. It is flexible—use for self-directed learning or with professionals in classroom or other settings, such as grand rounds. It embraces a humanistic perspective, with awareness of class, race and cultural difference. Justin’s Story is a case study made up of lively intimate movie clips, competencies and objectives, discussion questions, take-home points, recommended reading/resource lists and a PowerPoint presentation. The University of Cincinnati Evaluation Services Center contracted to complete the evaluation.
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Reichert J, Parmelee D, Bognar S, Durgans K, Godoy M. A LION IN THE HOUSE Module for Health Care Education: Pediatric End-of-Life Case Studies. MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/publication/8362 http://dx.doi.org/10.15766/mep_2374-8265.8362
- To develop strategies for the honest disclosure of prognosis, treatment options and goals of care, without taking away hope.
- To recommend ways to incorporate palliative care interventions concurrent with disease-directed treatments early in the treatment process.
- To articulate an approach for involving the patient and family in decision-making without placing inappropriate burdens in these decisions on them.
- A Lion in the House, Childhood Cancer, Death (MeSH), Truth Disclosure
Hospice & Palliative Medicine
- Pediatric Hematology-Oncology
- Hospice & Palliative Medicine
Interpersonal & Communication Skills
Knowledge for Practice
End of Life Care
- Psychology/Behavioral Science
- Clinical Skills/Doctoring
- Medical Student
Professional School Post-Graduate Training
Authors & Co-Authors
Julia Reichert, Academy Award Nominated Filmmaker & Director
Wright State University Boonshoft School of Medicine
Dean Parmelee, MD
Wright State University Boonshoft School of Medicine
Karen Durgans, MS
Community Media Productions Inc.
Community Media Productions Inc.
Melissa Godoy, BS
Community Media Productions Inc. and Cinema Sol Ltd.
Authors have significant financial interest or commercial support.
Community Media Productions, Inc., a nonprofit organization, received funding from the Centers for Disease Control and Prevention, the Independent Television Service, the Corporation for Public Broadcasting, a Lance Armstrong Foundation Community Program Grant and the E. Lee Walker Imagination Award to create, promote and distribute the LION IN THE HOUSE Modules for Health Care Education. Community Media Productions contracted with Aquarius Health Care Media to be the official distributor of the modules through www.aquariusproductions.com/lion.
Sponsorship or Funding Source
Community Media Productions, Inc., received funding from the Centers for Disease Control and Prevention, a Lance Armstrong Foundation Community Program Grant and the E. Lee Walker Imagination Award to create, promote and distribute the LION IN THE HOUSE Modules for Health Care Education.
Effectiveness and Significance
Community Media Productions contracted with the University of Cincinnati Evaluation Services Center to evaluate the LION Modules for Health Care Education. From November 2008 through October 2009, 2,168 participants were exposed to the modules, mostly through conference trainings and classrooms. Additionally, 1,100 pediatric nurses were trained in courses using the Lion modules through the End-of-Life Nursing Education Consortium Pediatric Palliative Care train-the-trainer sessions. 629 participants were trained in 13 different forums from 37 states, with 391 completing evaluation surveys. Of these, respondents to the Pediatric End-of-Life Module surveys (n=205) reported the following improvements: 65.4% were more likely to draw upon the strengths of the full health care team to communicate sensitively with the patient’s family at child end-of-life; 67.3% would better integrate a family’s religious and/or spiritual health care beliefs into discussions of treatment options; 95.6% were more sensitive to the balance between involving the family in decision-making and placing inappropriate burdens for these decisions on parents; and 92.7% would be more aware of their own personal reactions regarding death and dying. Respondents noted their top take-home points from the Pediatric End-of-Life Module: (1) Talk to patients about their wishes; (2) Communicate meaningfully with the family, bearing truth with more empathy; provide more comfort and support for families, especially parents; and, (3) Educate and train staff on pediatric palliative care issues; communicate and collaborate with peers/staff. Many survey respondents noted the following challenges they would likely meet: (1) Better use of the interdisciplinary team, especially when treatments are futile; (2) Current culture within medicine and within the institution; (3) Difficulty in dealing with families seeking for answers but no remedy; family not ready for end-of-life.
Special Implementation Guidelines or Requirements
The curriculum is streamlined, and the language is designed to provoke a more robust and open discussion. The challenge is to allow the material, the process, and the abilities of the facilitators and students to generate a learning experience that allows for self-examination and exploration in a safe and professional environment.
Suggested audiovisual materials include a DVD player, screen, projector, and a good sound system or cable (the DVD works most reliably when shown on a DVD player rather than a computer). Use a computer with the optional PowerPoint presentation.
Overall, the positive reactions to the honesty and reality reflected throughout the situations encountered by LION families have propelled the modules into highly effective conversation starters. The case studies portray the struggles in the midst of believability and compassion and thus open the door for entry into difficult topics. The intimate real-life case studies in the LION Educational Modules tend to spark deep emotions, often bringing up unexpected reactions in participants and presenters alike. It is very challenging to allow and encourage participants to acknowledge those reactions and explore the underlying judgments that accompany the reactions in an environment of safety and professionalism. The positive effect of the modules has been the ability to increase one’s awareness of personal and professional reactions to patient and family medical situations and crises in the context of a wider socio-economic system with important implications for patient care. A medical professional’s expectations and judgments towards a patient/family can negatively or positively impact health care choices and recommendations, including referrals for supportive care, follow-up testing, and clinical trial studies, among others. Getting those reactions out into the open provides the opportunity to examine one's health care beliefs and the choices and behaviors that accompany them.
This information is made available under the Creative Commons license.
Publications, Presentations, and/or Citations for this Publication
Citations to Resource:
- Abrash, B: A Lion in the House: A Content-Centered Outreach Strategy for Public Broadcasting. American University Center for Social Media; November 2007.
- American Society of Clinical Oncology: Pediatric Cancer Documentary Highlights Challenging Aspects of Cancer Care. ASCO News and Forum; October 2006.
- Burki, T: Lion-Hearts. The Lancet Oncology; 2006 June 7(6): 465-466. http://dx.doi.org/10.1016/s1470-2045(06)70722-7
- Dickens, DS: Building Competence in Pediatric End-of-Life Care. Journal of Palliative Medicine; 2009 July 12(7): 617-622. http://dx.doi.org/10.1089/jpm.2009.0032
- Independent Television Service: A Lion in the House Community Engagement Campaign Report: Executive Summary. Independent Lens; June 2007. Available from: archive.itvs.org/outreach/lioninthehouse/resources/lion_summary.pdf.
- National Cancer Institute Center to Reduce Health Disparities: NCI Examines How to Partner With PBS to Promote Video on Childhood Cancer. Equal Access; 2005 2(1): p.10.
Presentations from Resource:
- Arceci R: Learning End-of-Life Care: The Media Can Help With The Message. American Society of Clinical Oncology Annual Meeting, Chicago, Illinois; June 2007.
- Bognar S, Reichert J: The Story of Tim Woods. The 9th Biennial Symposium on Minorities, The Medically Underserved & Cancer, Washington, DC; March 2004.
- Durgans K: Pediatric End-of-Life Case Studies. End-of-Life Nursing Education Consortium-Pediatric Palliative Care Train-the-Trainer Program, Sacramento, California; February 2009.
- Godoy M, Reichert J: Cancer Stories: The Impact of Narrative on a Modern Malady. Indiana University-Purdue University at Indianapolis—A Medical Humanities Symposium, Indianapolis, Indiana; November 2008.
- Parmelee D, Reichert J: A Lion in the House: Strategizing the Use of Intimate Real-Life Case Studies in Pediatric End-of-Life in Medical Education. Association of American Medical Colleges Annual Meeting, San Antonio, Texas; November 2008.
Contains materials or information owned by other parties
- Justin Ashcraft—main patient/character--PHOTO
- Dale Ashcraft—father of Justin--PHOTO
- Debbie Ashcraft (Kenner)—mother of Justin--PHOTO
- Susan Ashcraft—step-mother to Justin--PHOTO
- Adam Ashcraft—brother of Justin--PHOTO
- Jennifer Ashcraft Roller—Sister of Justin--PHOTO
- Blanket Hospital Release Form covering all medical/nursing staff--PHOTOS
- Aquarius Health Care Media (Distributor)—STREAM segments of The Lion in the House modules, including Justin’s Story, along with printed materials
- Ian Anderson Continuing Education Program in End-of-Life Care—SLIDES
- End-of-Life Nursing Education Consortium Pediatric Palliative Care--SLIDES
- Center to Advance Palliative Care—SLIDE