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基于病例的姑息治疗工作坊对普通外科住院医师的可行性和影响。

Feasibility and impact of a case-based palliative care workshop for general surgery residents.

机构信息

Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

出版信息

J Am Coll Surg. 2012 Feb;214(2):231-6. doi: 10.1016/j.jamcollsurg.2011.11.002. Epub 2011 Dec 9.

Abstract

BACKGROUND

The American Board of Surgery has emphasized that palliative care education should be included in surgical training. The few formal curricula for teaching palliative care, although effective, are time-intensive and have low longitudinal participation rates. The aim of this project was to design a feasible and effective palliative care intervention for general surgery residency training.

STUDY DESIGN

A multidisciplinary group developed a 2-hour case-based palliative care workshop including a brief introductory didactic, 4 case-based scenarios, and role-playing exercises. Program effectiveness was assessed using pre- and 3 weeks post-workshop surveys to measure attitudes toward and knowledge of palliative care. Fisher's exact test was used for data analysis; statistical significance was accepted at p < 0.05.

RESULTS

Twenty-two (88%) residents attended the workshop and completed the baseline survey; 16 (72.7%) completed the post-workshop survey. The workshop changed residents' attitudes to be more consistent with accepted palliative care principles. Statistically significant shifts were seen in attitudes about the use of total parenteral nutrition for malignant small bowel obstruction (31.8% disagree with use pre- vs 68.8% post-workshop; p < 0.0001); the use of surgical therapy for malignant small bowel obstruction (45.5% disagree pre- vs 68.8% post-workshop; p = 0.002); and that depression is normal in terminal illness (22.7% disagree pre- vs 43.8% post-workshop; p = 0.002). Residents also performed considerably better on knowledge questions about CPR, patient autonomy, and withdrawal of life-sustaining therapy.

CONCLUSIONS

A brief, interactive workshop is effective in changing general surgery residents' attitudes toward and knowledge of palliative care. The results demonstrate that a single teaching session is a useful intervention.

摘要

背景

美国外科学会强调,姑息治疗教育应纳入外科培训。尽管少数教授姑息治疗的正规课程行之有效,但它们耗时且纵向参与率低。本项目旨在为普通外科住院医师培训设计一种可行且有效的姑息治疗干预措施。

研究设计

一个多学科小组开发了一个 2 小时的基于案例的姑息治疗研讨会,包括简短的介绍性讲座、4 个基于案例的情景和角色扮演练习。使用预研讨会和 3 周后的问卷调查来评估方案的有效性,以衡量对姑息治疗的态度和知识。Fisher 精确检验用于数据分析;p<0.05 为统计学显著。

结果

22 名(88%)住院医师参加了研讨会并完成了基线调查;16 名(72.7%)完成了研讨会后的调查。该研讨会改变了住院医师的态度,使其更符合公认的姑息治疗原则。在使用全胃肠外营养治疗恶性小肠梗阻的态度方面,观察到统计学上的显著转变(31.8%的人不同意使用,而 68.8%的人同意使用;p<0.0001);使用手术治疗恶性小肠梗阻的态度也发生了转变(45.5%的人不同意使用,而 68.8%的人同意使用;p=0.002);并且认为抑郁在终末期疾病中是正常的(22.7%的人不同意使用,而 43.8%的人同意使用;p=0.002)。住院医师在心肺复苏、患者自主权和停止维持生命的治疗等知识问题上的表现也有了显著提高。

结论

一个简短的互动研讨会可以有效地改变普通外科住院医师对姑息治疗的态度和知识。结果表明,单次教学课程是一种有用的干预措施。

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