Clark Jeanne M, Lurie Jon D, Claessens Michael T, Reed Virginia A, Jernstedt G Christian, Goodlin Sarah G
Johns Hopkins University School of Medicine, Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Palliat Care. 2003 Winter;19(4):253-7.
To assess knowledge and associated factors in palliative care.
Self-administered survey of 88 internal medicine house officers in 1996.
Twenty-one interns and 36 residents completed the survey for a response rate of 65%. Most house officers reported 1-5 hours of prior formal training in palliative care, 1-5 hours in pain management, and 6-20 hours in ethics. The mean knowledge score was 75% correct (SD = 8); pain management scores were lowest (70%). Overall, interns had a significantly lower mean score than residents (70% vs. 77%; p = 0.001). In multivariate analysis, only the year of residency was significantly associated with knowledge score; prior formal training in palliative care, pain management, or ethics was not. One third of house officers rated themselves as "not at all" or "only slightly" at ease in caring for a dying patient. These self-ratings were not associated with prior training or knowledge, but were higher in residents compared to interns.
Palliative care knowledge and ease with dying patients were higher in later years of residency but were not associated with prior formal palliative care training. These data highlight the continued need to evaluate and improve training in palliative care and pain management.
评估姑息治疗方面的知识及相关因素。
1996年对88名内科住院医师进行了自我管理式调查。
21名实习医生和36名住院医师完成了调查,回复率为65%。大多数住院医师报告称之前接受过1 - 5小时的姑息治疗正规培训、1 - 5小时的疼痛管理培训以及6 - 20小时的伦理学培训。平均知识得分正确率为75%(标准差 = 8);疼痛管理得分最低(70%)。总体而言,实习医生的平均得分显著低于住院医师(70%对77%;p = 0.001)。在多变量分析中,只有住院年限与知识得分显著相关;之前在姑息治疗、疼痛管理或伦理学方面的正规培训则无此关联。三分之一的住院医师认为自己在照顾临终患者时“一点也不”或“只是稍有”轻松感。这些自我评估与之前的培训或知识无关,但住院医师的自我评估高于实习医生。
在住院医师培训的后期阶段,姑息治疗知识以及照顾临终患者时的轻松感有所提高,但与之前接受的正规姑息治疗培训无关。这些数据凸显了持续评估和改进姑息治疗及疼痛管理培训的必要性。