title: The use of reflective diaries in end of life training programmes: a study exploring the impact of self-reflection on the participants in a volunteer training programme.
abstract: BACKGROUND
  A training programme was developed and delivered to a cohort of volunteers who were preparing for a unique role to provide companionship to dying patients in the acute hospital setting. This comprehensive programme aimed to provide an opportunity for participants to fully understand the nature and responsibilities of the role, whilst also allowing sufficient time to assess the qualities and competencies of participants for their ongoing volunteering role. Participants completed reflective diaries throughout the training course to record their ongoing thoughts and feelings. The purpose of this paper is to present a phenomenological analysis of these entries to understand participants' experiences, perceptions and motivations.
  
  
  METHODS
  The wider study was structured into three phases. Phase 1 was the delivery of a 12 week, bespoke training programme; Phase 2 involved a 26 week pilot implementation of the Care of the Dying Volunteer Service and Phase 3 was the research evaluation of the training and implementation which would inform the further development of the training programme. Self-reflection is a common component of End of Life training programmes and volunteers in this study completed a reflective diary after participation in each of the training sessions. A thematic analysis was undertaken to explore and understand the participants' experience, perceptions and motivations in relation to their participation in the training.
  
  
  RESULTS
  All 19 volunteers completed the reflective diaries. From a potential 228 diary entries over the 12 week training programme, 178 diary entries were submitted (78 %). The following key themes were identified: Dying Alone and the importance of being present, Personal loss and the reconstruction of meaning, Self-Awareness and Personal growth, Self-preservation and Coping strategies and group unity/cohesion.
  
  
  CONCLUSIONS
  The participants in this study demonstrated that they were able to use the diaries as an appropriate medium for reflection. Their reflections were also instrumental in the ongoing revision and development of the training programme. Analysis of their entries illustrated that the diaries could provide the opportunity for a reappraisal of their world view and personal philosophy around death and dying. Further research is undoubtedly required, however this paper suggests that self-reflection in this way, supports preparation in honing the appropriate attitudes and qualities required to work in this role.
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. agermain@liverpool.ac.uk.
authors.forename: Alison
authors.initials: A
authors.lastname: Germain
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. kate.nolan@live.co.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Nolan
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. Rita.Doyle@rlbuht.nhs.uk.
authors.forename: Rita
authors.initials: R
authors.lastname: Doyle
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. Stephen.Mason@liverpool.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mason
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. Maureen.Gambles@liverpool.ac.uk.
authors.forename: Maureen
authors.initials: M
authors.lastname: Gambles
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. Hong.chen@hyms.ac.uk.
authors.forename: Hong
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. palled@swissonline.ch.
authors.forename: Ruthmarijke
authors.initials: R
authors.lastname: Smeding
authors.affiliation: Department of Molecular & Clinical Cancer Medicine, Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Cancer Research Centre, 200 London Road, Liverpool, L3 9TA, UK. j.e.ellershaw@liverpool.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Ellershaw
mesh_terms: D004493:Education / Q000379:methods; D005260:Female; D033062:Friends / Q000523:psychology*; D006801:Humans; D008297:Male; D036301:Qualitative Research; D057566:Self Report; D013727:Terminal Care / Q000379:methods* / Q000523:psychology*; D014838:Volunteers / Q000523:psychology*