Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Palliat Med. 2010 Apr;13(4):439-52. doi: 10.1089/jpm.2009.0262.
Internal medicine residents are largely unprepared to carry out end-of-life (EOL) conversations. There is evidence that these skills can be taught, but data from randomized controlled trials are lacking.
We studied whether a day-long communication skills training retreat would lead to enhanced performance of and confidence with specific EOL conversations. We also studied the effect of the retreat on residents' ability to respond to patient emotions.
PGY-2 resident volunteers were randomly assigned to a retreat group or a control group. The retreat involved a combination of teaching styles and skills practice with standardized patients. All participants completed questionnaires and were evaluated carrying out two types of conversations (breaking bad news or discussing direction of care) with a standardized patient before (T1) and after (T2) the intervention phase. Conversations were audio-taped and later rated by a researcher blinded to group assignment and time of assessment.
Forty-nine residents agreed to randomization (88%) with 23 residents randomized to the retreat group and 26 to the control group. Compared to controls, retreat participants demonstrated higher T2 scores for breaking bad news, discussing direction of care, and responding to emotion. Comparing T2 to T1, the retreat group's improvement in responding to emotion was statistically significant. The retreat group's confidence improved significantly only for the breaking bad news construct.
A short course for residents can significantly improve specific elements of resident EOL conversation performance, including the ability to respond to emotional cues.
内科住院医师在进行临终（EOL）谈话方面基本上没有准备。有证据表明这些技能可以教授，但缺乏随机对照试验的数据。
我们研究了为期一天的沟通技巧培训静修是否会提高特定 EOL 对话的表现和信心。我们还研究了静修对住院医师回应患者情绪的能力的影响。
PGY-2 住院医师志愿者被随机分配到静修组或对照组。静修包括教学风格和与标准化患者一起进行技能练习的结合。所有参与者在干预前（T1）和干预后（T2）完成问卷调查，并与标准化患者进行两种类型的对话（告知坏消息或讨论护理方向）进行评估。对话被录音，然后由一名对分组和评估时间不知情的研究人员进行评分。
49 名住院医师同意随机分组（88%），其中 23 名住院医师被随机分配到静修组，26 名住院医师被分配到对照组。与对照组相比，静修组在告知坏消息、讨论护理方向和回应情绪方面的 T2 评分更高。与 T1 相比，静修组在回应情绪方面的改善具有统计学意义。仅在告知坏消息结构方面，静修组的信心显著提高。
短期课程可以显著提高住院医师特定的 EOL 对话表现，包括回应情绪提示的能力。
