使用口袋卡片提高内科临床教学单元的临终关怀：一项整群随机对照试验。
Using a pocket card to improve end-of-life care on internal medicine clinical teaching units: a cluster-randomized controlled trial.
机构信息
Division of Hematology-Oncology, Mayo Clinic, Arizona 85259, USA.
出版信息
J Gen Intern Med. 2008 Aug;23(8):1222-7. doi: 10.1007/s11606-008-0582-4. Epub 2008 Apr 30.
BACKGROUND
End-of-life care is suboptimally taught in undergraduate and postgraduate education in Canada. Previous interventions to improve residents' knowledge and comfort have involved lengthy comprehensive educational modules or dedicated palliative care rotations.
OBJECTIVE
To determine the effectiveness of a cheap, portable, and easily implemented pocket reference for improving residents' knowledge and comfort level in dealing with pain and symptom management on the medical ward.
DESIGN
Cluster-randomized controlled trial conducted from August 2005 to June 2006.
SETTING
Medical clinical teaching units (CTUs) in 3 academic hospitals in Toronto, Canada.
PARTICIPANTS
All residents rotating through the medical CTUs who consented to participate in the study.
INTERVENTION
Residents at 1 hospital received a pocket reference including information about pain and symptom control, as well as 1-2 didactic end-of-life teaching sessions per month normally given as part of the rotation. Residents at the other 2 hospitals received only the didactic sessions.
MAIN OUTCOME MEASURES
A 10-question survey assessing knowledge and comfort level providing end-of-life care to medical inpatients, as well as focus group interviews.
RESULTS
One hundred thirty-six residents participated on 3 CTUs for a participation rate of approximately 75%. Comfort levels improved in both control (p < .01) and intervention groups (p < .01), but the increase in comfort level was significantly higher in the intervention group (z = 2.57, p < .01). Knowledge was not significantly improved in the control group (p = .06), but was significantly improved in the intervention group (p = .01). Greater than 90% of residents in the intervention group used the card at least once per week, and feedback from the focus groups was very positive.
CONCLUSIONS
Our pocket card is a feasible, economical, and educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on CTUs.
背景
在加拿大，本科和研究生教育中临终关怀的教学效果并不理想。之前为提高住院医师的知识和舒适度而进行的干预措施涉及冗长的综合教育模块或专门的姑息治疗轮转。
目的
确定一种廉价、便携且易于实施的袖珍参考资料，用于提高住院医师在医疗病房处理疼痛和症状管理方面的知识和舒适度，是否有效。
设计
2005 年 8 月至 2006 年 6 月进行的整群随机对照试验。
地点
加拿大多伦多 3 家学术医院的医疗临床教学单位（CTU）。
参与者
所有同意参加该研究的在医疗 CTU 轮转的住院医师。
干预措施
一家医院的住院医师收到了一本袖珍参考资料，其中包括有关疼痛和症状控制的信息，以及每月 1-2 次的临终关怀教学课程，这些课程通常是轮转的一部分。另外 2 家医院的住院医师仅接受教学课程。
主要观察指标
评估向住院内科患者提供临终关怀的知识和舒适度的 10 个问题调查，以及焦点小组访谈。
结果
共有 136 名住院医师在 3 个 CTU 参加了研究，参与率约为 75%。对照组（p<0.01）和干预组（p<0.01）的舒适度均有所提高，但干预组的舒适度提高幅度显著更高（z=2.57，p<0.01）。对照组的知识水平没有显著提高（p=0.06），但干预组的知识水平显著提高（p=0.01）。干预组中超过 90%的住院医师每周至少使用该卡片一次，焦点小组的反馈非常积极。
结论
我们的袖珍卡片是一种可行、经济且具有教育意义的干预措施，可提高住院医师在 CTU 提供临终关怀方面的舒适度和知识水平。
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