Department of General Practice & Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
BMC Fam Pract. 2013 Jul 2;14:93. doi: 10.1186/1471-2296-14-93.
Communicating effectively with palliative care patients has been acknowledged to be somewhat difficult, but little is known about the effect that training general practitioners (GPs) in specific elements of communication in palliative care might have. We hypothesized that GPs exposed to a new training programme in GP-patient communication in palliative care focusing on availability of the GP for the patient, current issues the GP should discuss with the patient and anticipation by the GP of various scenarios (ACA), would discuss more issues and become more skilled in their communication with palliative care patients.
In this controlled trial among GPs who attended a two-year Palliative Care Peer Group Training Course in the Netherlands only intervention GPs received the ACA training programme. To evaluate the effect of the programme a content analysis (Roter Interaction Analysis System) was performed of one videotaped 15-minute consultation of each GP with a simulated palliative care patient conducted at baseline, and one at 12 months follow-up. Both how the GP communicated with the patient ('availability') and the number of current and anticipated issues the GP discussed with the patient were measured quantitatively. We used linear mixed models and logistic regression models to evaluate between-group differences over time.
Sixty-two GPs were assigned to the intervention and 64 to the control group. We found no effect of the ACA training programme on how the GPs communicated with the patient or on the number of issues discussed by GPs with the patient. The total number of issues discussed by the GPs was eight out of 13 before and after the training in both groups.
The ACA training programme did not influence how the GPs communicated with the simulated palliative care patient or the number of issues discussed by the GPs in this trial. Further research should evaluate whether this training programme is effective for GPs who do not have a special interest in palliative care and whether studies using outcomes at patient level can provide more insight into the effectiveness of the ACA training programme.
Current Controlled Trials ISRCTN56722368.
与姑息治疗患者进行有效的沟通已被认为有些困难，但对于培训全科医生（GP）在姑息治疗中掌握特定沟通技巧的效果知之甚少。我们假设，接受过新的姑息治疗中 GP 与患者沟通培训计划（重点关注 GP 对患者的可用性、GP 应与患者讨论的当前问题以及 GP 对各种情况的预期（ACA））的 GP 会讨论更多问题，并在与姑息治疗患者的沟通中变得更加熟练。
在荷兰的一项针对参加为期两年姑息治疗同行小组培训课程的 GP 的对照试验中，仅干预组的 GP 接受了 ACA 培训计划。为了评估该计划的效果，对每位 GP 与模拟姑息治疗患者进行的 15 分钟视频咨询进行了内容分析（Roter 互动分析系统），基线时进行一次，12 个月随访时进行一次。使用线性混合模型和逻辑回归模型来评估随时间的组间差异。
共有 62 名 GP 被分配到干预组，64 名 GP 被分配到对照组。我们没有发现 ACA 培训计划对 GP 与患者沟通方式或 GP 与患者讨论的问题数量有影响。在培训前后，两组 GP 讨论的问题总数均为 13 个中的 8 个。
ACA 培训计划并未影响 GP 与模拟姑息治疗患者的沟通方式或 GP 在本试验中讨论的问题数量。进一步的研究应评估该培训计划对没有姑息治疗特殊兴趣的 GP 是否有效，以及使用患者水平的结果的研究是否可以更深入地了解 ACA 培训计划的有效性。
当前对照试验 ISRCTN56722368。
