College Palliative Care Volunteers: Too Early to Feed the Pipeline for Palliative Care Clinicians?

Abstract

Background: The University of Iowa Hospitals and Clinics (UIHC) has a palliative care (PC) volunteering program that has recruited college students since 2010. There is little research on the effects of PC volunteering on collegiate volunteers.

Objective: The objective is to determine the impact of PC volunteering on college students' professional lives and on their interest in PC.

Design/Setting/Measurements: The UIHC Volunteer Services office sent a 25-question survey with closed- and open-ended items to previous and current PC college volunteers. We used descriptive statistics to characterize the sample. Free text responses were analyzed using a descriptive qualitative approach with three independent coders.

Results: Seventy-one percent of respondents (23/33) reported they were more likely to pursue PC after volunteering. PC volunteering helped change views of patient care and abilities to discuss end-of-life situations. Ninety-one percent served as informal ambassadors by discussing PC with family and peers. Major themes identified include motivation to volunteer for patient contact and interest in learning about PC. Respondents described meaningful patient interactions, lessons in empathy, and the power of listening.

Conclusions: These results suggest that PC volunteering affects career choices and helps volunteers gain needed listening skills for patient care in the future. The unique exposure and interactions with PC patients and their families have changed volunteers' understanding of health care. PC volunteers speak in their social networks about PC. This experience may increase the likelihood of student volunteers to pursue careers in PC.

Introduction

Volunteers provide a comforting presence, help build legacy, and address grief in hospice care¹ but are underutilized in palliative care (PC). Studies of PC volunteering outside the United States have shown the same benefits to patients/families as those reported in hospice care.^2–4 These benefits include reduced stress by providing a listening ear and helping with minor tasks. For health systems, patient satisfaction appeared higher in hospitals with higher number of volunteer hours in patient areas. In addition, the financial benefits of hospital volunteer programs appear to exceed the cost of the program, suggesting some cost savings with strong volunteer programs.^5,6 However, the impacts of PC volunteering on the volunteers themselves are less known. Only two studies have reported the impact of PC volunteering on the volunteers,^7–9 one with primarily older adults (average age of 61.6 years),⁷ and the other study focused on undergraduate nursing students.^8,9

Since 2010, the University of Iowa Hospitals and Clinics (UIHC) PC volunteering program provides a well-structured program for community and student volunteers. Volunteers are asked to make a weekly commitment of 2.5 hours. Incoming volunteers undergo an orientation, including training in empathic listening, providing companionship, and legacy building. They are instructed to watch and read through educational materials about their assigned unit and about PC in general. Volunteers have an individual training session with the volunteer coordinator and shadow an experienced volunteer for a 2.5-hour-long shift before volunteering independently. Once orientation is complete volunteers spend two hours each week with PC patients and families throughout the hospital. Visits typically consist of having conversations with patients and family members, providing a presence or listening ear, reading to patients, and/or taking hand photos (photos of the hand of the patient with the hands of family members) for families.

With the increasing demand for PC clinicians,¹⁰ effective programs are needed to introduce PC to health science students, thereby stimulating interest in PC in their career. The purpose of this study was to determine the personal and professional impact that PC volunteering has on college students; specifically whether volunteering positively influenced their interest in future involvement with PC and whether student PC volunteers served as informal ambassadors about PC in their peer groups and families.

Methods

Sample and data collection

An anonymous survey containing 25 open- and closed-ended questions was e-mailed by UIHC Volunteer Services to all (n = 88) prior and current student PC volunteers. Owing to out-of-date e-mail addresses, 78 of the 88 student volunteers received the survey. The response rate was 42% (33/78). The survey consisted of demographic questions about the volunteer and questions about how PC volunteering affected them on a personal and professional level. This study was approved by the University of Iowa Institutional Review Board.

Analysis

Descriptive statistics were used to characterize the sample and the responses to closed-ended survey items. Qualitative description was used to analyze the free-text responses to the open-ended questions using a bottom-up approach.¹¹ The free text entries were reviewed and coded independently by the authors. Codes were compared and discussed until consensus was achieved and then organized into major themes.

Results

A total of 33 PC volunteering college students completed the survey; 64% were female students, and >50% began volunteering during their sophomore year or earlier. More than 42% had been volunteering in PC for three or more semesters, and 57% stopped volunteering only due to graduation (Table 1 provides a description of the sample.).

Table 1.

Description of College Student Palliative Care Volunteer Sample (N = 33)

	n (%)
Gender
Male	11 (33.33)
Female	21 (63.64)
Other	1 (3.03)
Starting volunteer at
Freshman	5 (15.15)
Sophomore	11 (33.33)
Junior	11 (33.33)
Senior	5 (15.15)
Other	1 (3.03)
Length of PC volunteering
<1 semester	4 (12.12)
1 semester	6 (18.18)
2 semesters	9 (27.27)
3 semesters	10 (30.30)
4 semesters	2 (6.06)
>4 semesters	2 (6.06)
Reasons for leaving PC volunteering (multiple select allowed)
Graduated	12 (57.14)
Too busy	7 (33.33)
Switched units	3 (14.29)
Did not enjoy it	2 (9.52)
Other	2 (9.52)
Are you in or preparing for a health care profession?
Yes	29 (93.55)
No	2 (6.45)

PC, palliative care.

PC volunteering affected respondents' career plans. When asked if they were “likely to go into healthcare,” 58% reported they were likely to choose a career in health before PC volunteering compared with 75% after PC volunteering. In addition, 71% reported that PC volunteering made them more likely to be involved in palliative or hospice care in the future. Similarly, 77% of respondents changed their view of patient care after PC volunteering, and 94% stated that PC volunteering has improved their ability to discuss end-of-life-situations. Finally, 88% respondents reported that they have initiated conversations about PC to individuals not already involved with it. Although 85% students felt some degree of stress during PC volunteering, 97% would recommend PC volunteering to others. Table 2 summarizes survey responses to PC volunteering experiences and career planning questions.

Table 2.

Palliative Care Volunteering Experiences and Career Planning (N = 33)

	n (%)
Likelihood to go into health care before PC volunteering
Very likely	19 (57.58)
Likely	12 (36.36)
Not likely	1 (3.03)
Very unlikely	1 (3.03)
Likelihood to go into health care after PC volunteering
Very likely	25 (75.76)
Likely	5 (15.15)
Not likely	2 (6.06)
Very unlikely	1 (3.03)
Has PC volunteering affected your career plans?
Yes	20 (62.50)
No	12 (37.50)
Has PC volunteering made you more likely to be involved in palliative or hospice care in the future?
Yes	22 (70.97)
No	9 (29.03)
Did PC volunteering change your view of patient care?
Yes	23 (76.67)
No	7 (23.33)
How much has PC volunteering improved your ability to discuss end-of-life situation?
A lot	18 (54.55)
A little	13 (39.39)
Not at all	2 (6.06)
Have you initiated any conversations(s) about PC to anyone not already involved with it?
Yes	29 (87.88)
No	3 (9.09)
How likely are you to recommend PC volunteering to others?
Very	25 (75.76)
Somewhat	6 (18.18)
Slightly	1 (3.03)
Not at all	1 (3.03)
How stressful was PC volunteering?
Very	2 (6.06)
Somewhat	10 (30.30)
Slightly	16 (48.48)
Not at all	5 (15.15)

Themes

Three major themes were identified, including “Exposure to patients,” “Larger contribution,” and “Impact on volunteer.” (See Table 3 for a description of the themes and exemplar quotes.)

Table 3.

Identified Themes and Exemplar Quotes

Themes	Subthemes	Exemplar quotes
Exposure to patients	Direct patient contact	“…has inspired me to pursue a health care profession in a field where I can have a relationship with my patient.”
	Hearing stories	“Most of the best memories I have are from just bonding with the patients and families over memories and good stories. It's not all the time that they can smile and laugh in the situations they are in.”
	Patient stage in life	“I had a lot of conversations about death and dying. Some patients were accepting of their condition and others were very scared. It was difficult to have those conversations.”
	Recommendations	“I heard from others within the Palliative Care Volunteering team that it was a much more intimate experience compared to other volunteering options. I decided to give it a try as I was getting frustrated that my previous volunteer experience lacked patient contact. I loved it all.”
	Personal experience	“Death is a taboo subject for so many people. However, it is one of the greatest moments to make an intimate connection with another individual. I understand these moments due to personal experiences, and therefore I wanted to be able to share myself with others in a way that was valuable to patients and families. Volunteering in palliative care gave me just that option. It allowed me to form connections with so many people and appreciate life in a way I never have before.”
Larger contribution	Making an impact	“I had made families and patients feel more comfortable just by listening to what they had to say. I learned that simply being available to someone can be therapeutic.”
	Helping hand/pay it forward	“…he just needed to talk to somebody about, and I was so glad that I was able to be there for him in such a vulnerable time.”
	Rewarding and meaningful	“It was kind of exhausting. I remember feeling incredibly melancholy after shifts, but it was so meaningful I didn't want to ever stop.”
Impact on volunteer	Empathy	“I am practicing how to offer empathy during extremely challenging times. I am learning how to listen more than I speak.”
	Outlook on life	“It changed my life. The experience humbled me greatly and reminded me that life is precious and so are the connections we make with others. Every person has a story worth listening to.”
	Career goals	“I realized beyond doubt I wanted to be a doctor. That was when I realized medical care can be beautifully human.”
	Getting to know the hospital/health care	“It made me realize the importance of holistic care-not just medical support, but emotional support, spiritual support, and so on.”
	Patient interaction skills	“It emphasized the human connection, gave me experience in starting conversations at the bedside not solely focused on someone's medical illness.”
	Fondest memory	“I had many a hilarious conversation with old folks during my time volunteering. One of my favorite memories was walking into a full-on party in one of the patients rooms. This family had some musical talent—there was guitar playing and singing, and I was immediately handed a cupcake.”
	Most difficult	“Speaking with the husband of a 32-year-old woman who had cervical cancer (she was sleeping). The cancer was apparently discovered while she was giving birth to their firstborn child. That was rough. It took me some time to emotionally recover from that visit. I remember leaving the room feeling very angry at the world.”

Exposure to patients

The volunteers had varied exposure to patients through direct patient contact, hearing stories from patients and families, and interactions in an end-of-life setting. Volunteers emphasized the importance of getting to interact directly with patients, to “offer them comfort and assistance, and simply learn about their lives.” Many volunteers reported gains in important skills and knowledge from their experience, such as learning how to better interact with patients.

Some participants reported their reasons for volunteering in PC included this desire to have patient interactions, and the ability to deal with end-of-life situations. Thirty-two of 33 respondents would recommend this program to their friends. One volunteer would not recommend it due to inadequate orientation, as her mentor unexpectedly had to cut her training session short. However, this was an atypical occurrence.

Larger contribution

PC student volunteers described their experience in terms of making a “larger contribution,” that is, a positive impact on the patients and families. PC volunteering was a way to provide a helping hand or pay it forward. Their PC volunteer experiences were frequently framed as rewarding and meaningful.

Impact on volunteer

The impact on the volunteer was the most frequent theme with several subthemes. PC volunteering increased their empathy, changed their outlook on life, and impacted their career goals. It helped them get to know the hospital, improved their patient interaction skills, and left them with positive yet difficult memories. A majority of respondents reported that PC volunteering has changed their perspective of patient care. They recognized “the power of listening” and its value as a therapeutic method. Many respondents reported that they are now better able to talk to their own family members who have serious illnesses and have improved their ability to discuss end-of-life situations. In addition, respondents reported that they have initiated conversations about PC with family members, friends, classmates, and/or other members of the community who were not previously familiar with PC.

Most of the volunteers' fondest memories involved listening to patients' stories, and being able to make a positive difference for them at a vulnerable time. Several volunteers described how some of the patients they visited had few visitors, and appreciated having someone there to listen. Volunteers also provided poignant examples of their most difficult experiences.

A majority of participants felt that PC volunteering helped shape their career paths, either encouraging them to pursue a medical professional career or steering them away from the medical profession to find a career that fits them better.

Discussion

This is the first study describing the impacts of PC volunteering on college students who have not yet begun their professional training. PC student volunteers directly interact with highly complex patients who are seriously ill. They meet with family members who are facing grief due to their loved ones' conditions, and learn to use empathic listening techniques to allow the patient and family to share their narrative. In addition, volunteers broaden their own view of patient care and treatment. Our participants indicated that PC volunteering has affected their bedside manner and approach to care.

Many of the college students are weighing career options. PC volunteering increased student interest in palliative or hospice care for the future. Respondents indicated that PC volunteering enhanced their ability to discuss care for the seriously ill patients and a majority initiated discussions about PC with their family members, friends, or classmates.

Limitations

These results reflect a single PC volunteer program and cannot be generalized to community volunteers, hospice volunteering, or other institutions. Volunteer orientation encourages students who feel they have strong communication skills to consider PC volunteering. As a result, PC volunteers who continue with the program may start out with greater confidence in approaching and interacting with patients.

Conclusion

PC volunteers help patients and families receiving PC.^2,12,13 Our study indicates that PC volunteering also benefits college students in their career choices and in developing important patient interaction skills. It is also possible that college students serving as PC volunteers can feed the pipeline of health care workers in PC and serve as a marketing tool for PC in their peer groups and in their families. The ripple effect of the collegiate volunteers in PC could be dramatic because their social groups include prehealth professionals and two generations in their own families. Future studies are needed to evaluate the impact of collegiate PC volunteering on feeding the pipeline to become future PC clinicians.

Author Disclosure Statement

No competing financial interests exist.