1. Creating competencies for hospice and palliative care professionals in Korea Jina Kang Hospice & Palliative Care Branch National Cancer Center, Korea

2. Background Competency defined as “The skills, knowledge, experience, attributes and behaviors required by an individual in order to perform the job effectively” (Royal college of Nursing, 2002) Competency-based assessment of professional development can help to provide a standardized content for cancer and palliative care education program. help individual practitioners to assess their own training and education skill requirements Provides a tool for those responsible for administering and encouraging their local personal performance review and development process (David Mitchell, 2003) Objectives describes the process and results of identifying the advanced competencies required by physicians, nurses, social workers and spiritual care providers in HPC practices

3. Defining core competency Advanced Competency Advanced Competency Team work EthicsEduca tion Rese arch Communic ation skills Psycho social care Spiritual care Care of the dying patients Bereav ement care Core Competency

4. Methods Defining core competency Setting the goals and guideline for compete ncy develop ment Describing a draft of competency Delphi Survey -2 round- Developing strategy for application TFT 7physicians 4nurses 2social workers 2clergies Knowledge Skills Attitudes

5. Framework for competency development Advanced Competency Advanced Competency Core Competency Physician Nurse Social worker Spiritual care provider Core Competency

6. Physician11 domain16 sub domain Nurse12 domain Social worker5 domain15sub domain Clergy4 domain Methods Describing a draft of competency Identified and described initial competencies by each professionals. Competencies was described as knowledge, skills, attitudes Domain of competencies

7. provides an opportunity for experts to communicate their opinions and knowledge anonymously about a complex problem It has been broadly used for development competencies of health professionals Used a two-round Delphi approach-e-mail survey Delphi panels : total 42 experts in HPC (13physicians,13nurses, 7clergies) Delphi survey Methods

8. 1 st Delphi survey whether the domains of competencies were valid –’yes’, ‘no’ rate how important each competency using 6- point Likert scale -‘absolutely not important’ (1) to ‘very important’ (5), and ‘unsure’ Methods

9. Results of 1 st Delphi survey  Response rate was 76%(32/42)  many of panels felt that it was not valid ; physicians 45%, nurses 50%, social workers 50%, spiritual care providers 80%.  Suggested opinion regarding to competency domains were identified as 20 items; 7 items for physician, 7items for nurse, 6 items for social worker  the criterion for consensus was set as mean score of 4.0.

10. 2 nd Delphi survey mailed to Delphi panels only to those who responed to the first round agreement rate about suggested opinions of round 1 was surveyed-using 5- point Likert scale: absolutely not agree’(1) to ‘strongly agree’(5) rate importance of each competency like round one. -‘absolutely not important’ (1) to ‘very important’ (5)

11. Response rate was 69%(22/32) Set the cutoff line for agreement ratings -mean score of 4.0- The opinions which came up to criterion were taken into consideration Results of 2 nd Delphi survey

12. Suggested opinion about competency domain from round one Consent rating (mean score)** Physicians 1.Integrate Communication and Goals of care with Advance care planning 3.1 2.Adding 'Concept of death' domain 3.8 3.Adjusting 'Ethics in palliative care' domain according to oxford textbook of palliative medicine* 3.0 4.Adjusting 'Physical care and treatment' domain according to normal categorization 2.6 5.Define 'palliative sedation' as independent domain 2.9 6.Adding the knowledge about complementary medicine in 'Physical care and treatment' domain 3.5 Nurses 1. Adding 'definition of palliative care' and 'geriatrics' 3.8 2. Integrating 'psychosocial care' with 'psychiatric treatment' 3.3 3.Adding 'complementary intervention' domain 3.7 4.Reduction in 'education' and 'research' domains 4.0 5.Combining Pain management, Symptom management and Psychosocial care in 'physical care' 1.8 6.Define 'family care' as independent domain 4.0 7.Integrating 'Care of the dying patients and bereaved family' domain into other domains(symptom management, psychosocial care.spiritual care) 2.8

13. Spiritual care providers Consent rating (mean score)** 1.Adding 'common medical knowledge' 3.0 2.Integrating 'religious care' with 'spiritual care' and classfying as 'communication','ethics'. and 'spiritual care' domains. 4.0 3.Adding 'anthropology' 2.8 4.Arranging 'communication' and 'religious care' as subcategories of 'spiritual care' 4.3 5.Correcting 'communication' domain as 'communication skills' 2.8 6.Correcting 'ethics' domain as 'medical ethics' 3.3 7.Correcting 'spiritual care' domain as 'spiritual assessment' 2.3 Results of 2 nd Delphi survey

14. Education Research Nurse Communitaion Ethics Spiritual Care Religious Care Spiritual care provider

15. Physicians Domain of competency Mean ± SD KnowledgeSkillAttitude 1.Introduction to palliative care4.42±.444.71±.224.83±.14 2. Palliative care system management4.31±.263.83±.234.63±.22 3.Communication4.65±.224.63±.254.90±.05 4.Ethics in palliative care4.55±.224.75±.074.81±.10 5.Education and research3.54±.204.00±.164.25±.13 6.Physical care and treatment 4.81±.174.85±.154.88±.11 7. Psychosocial care4.34±.164.10±.304.63±.00 8. Spiritual care4.27±.214.41±.194.63±.00 9. Care of the dying patients and their family4.80±.134.88±.004.90±.06 10. Bereavement care4.20±.394.07±.234.58±.07 11. Paediatrics & Adolescent care4.28±.134.25±.114.63±.00 Results of 2nd delphi survey : Physician Importance rating for competency

16. Nurse Mean±SD KnowledgeSkillAttitude 1.Pain management4.55±.254.74±.355.00±.00 2.Symptom management4.64±.294.84±.175.00±.00 3.Psychosocial care4.53±.264.34±.535.00±.00 4.Spiritual care4.24±.524.08±.794.96±.09 5.Communication3.67±.694.67±.415.00±.00 6.Care of the dying patients and bereaved family 4.40±.724.20±.915.00±.00 7.Management and quality assurance3.91±.833.58±.755.00±.00 8.Paediatrics & Adolescent care4.76±.084.85±.285.00±.00 9.Psychiatric treatment4.42±.354.60±.214.85±.19 10.Ethis in palliative care4.34±.544.94±.105.00±.00 11.Education and research2.87±.263.16±.704.80±.16 Results of 2nd delphi survey : Nurse Importance rating for competency

17. Results of 2nd delphi survey : Social worker Social worker Mean±SD KnowledgeSkillAttitude 1.Advocacy, Ethics and Values 4.64±.294.51±.474.92±.15 Ethics in HPC social worker4.56±.344.33±.705.00±.00 Empowerment and advocacy4.71±.234.61±.294.83±.19 2.Psychosocial care4.76±.244.64±.224.74±.33 Assessment4.94±.144.67±.004.67±.67 Care planning/Intervention4.83±.194.56±.214.60±.15 Individual care4.71±.12 4.78±.19 Group care4.42±.174.43±.164.75±.17 Family care4.83±.284.94±.145.00±.00 3.Community capacity building4.60±.394.56±.384.87±.25 Program development4.53±.304.27±.155.00±.00 Fund-raising and promoting4.27±.434.17±.184.67±.33 Access to community resource4.33±.004.44±.245.00±.00 Discharge planning4.67±.414.72±.424.75±.32 Supervise volunteers5.00±.004.96±.125.00±.00 4.Bereavement care5.00±.004.94±.145.00±.00 5.Evaluaion, education and research 4.47±.394.83±.334.83±.31 Evaluatioin and quality assurance4.30±.404.88±.275.00±.00 Education and research4.67±.294.76±.424.73±.37 Importance rating for competency

18. Spiritual care providers Mean±SD KnowledgeSkillAttitude 1.Communication5.00±.004.71±.305.00±.00 2.Ethics4.83±.204.88±.145.00±.00 3.Spiritual care4.89±.264.82±.315.00±.00 Religious care4.96±.104.80±.285.00±.00 Results of 2nd delphi survey : Spiritual care providers Importance rating for competency

19. It is important to explain the role of multidisciplinary team in HPC and what they have to contribute to the care of the patient. The National Cancer Center and the Korean Society of Hospice & Palliative Care created the competency for HPC professional’s competency and these competencies will be very useful to develop and evaluate the advanced course for each professional Conclusion