Lamiani Giulia, Gallieni Maurizio, Strada Irene, Vegni Elena
G Ital Nefrol. 2013 May-Jun;30(3).
Nephrologists often have to discuss difficult news with patients such as discussing treatment and prognosis, forgoing dialysis or end-of-life. Despite this, there are few educational interventions in this field. The aim of this study is to assess the efficacy of a workshop on difficult conversations in dialysis.
Within the Program to Enhance Relational and Communication Skills (PERCS) we developed a 4-hour workshop focused on communication in dialysis (PERCS-dialysis) at San Paolo Hospital,Milan. The workshop is geared around the enactment and debriefing of a case scenario. The scenario involves three conversations with a patient and a family member on dialysis and transplant. Before and after the workshop, participants are asked to complete a questionnaire on: sense of preparation, communication skills, relational skills, confidence and anxiety. The post-questionnaire also included some open-ended questions on the learning experience.
81 clinicians participated to 8 workshops. After the workshop, participants reported better preparation (p=.000) and confidence (p=.000). Perceived communication skills (p=.060), relational skills (p=.438) and anxiety (p=.441) improved but not significantly. All participants (100%) would recommend the workshop. In the open-ended questions participants reflected on the learning, appreciated the interactive methodology and offered suggestions.
Consistently with the educational objectives, clinicians improved their preparedness and confidence in holding difficult conversations. Clinicians perception of their communication and relational abilities did not change. To affect these skills a longer and more intensive training is probably needed.
肾病学家常常需要与患者讨论一些棘手的消息，比如治疗方案和预后、放弃透析或临终关怀等。尽管如此，该领域的教育干预措施却很少。本研究的目的是评估一场关于透析中艰难对话的工作坊的效果。
在“提升关系与沟通技巧项目”（PERCS）中，我们在米兰圣保罗医院开展了一个为期4小时的聚焦于透析沟通的工作坊（PERCS - 透析）。该工作坊围绕一个病例场景的演练和总结展开。这个场景包括与一位透析及移植患者及其家属进行的三次对话。在工作坊前后，要求参与者完成一份关于以下方面的问卷：准备感、沟通技巧、关系技巧、信心和焦虑程度。问卷的最后还包括一些关于学习体验的开放式问题。
81名临床医生参加了8场工作坊。工作坊结束后，参与者表示准备更充分（p = 0.000）且信心增强（p = 0.000）。感知到的沟通技巧（p = 0.060）、关系技巧（p = 0.438）和焦虑程度（p = 0.441）有所改善，但不显著。所有参与者（100%）都推荐该工作坊。在开放式问题中，参与者反思了学习情况，对互动式方法表示赞赏并提出了建议。
与教育目标一致，临床医生在进行艰难对话时的准备程度和信心有所提高。临床医生对自身沟通和关系能力的认知没有改变。可能需要更长时间、更密集的培训才能影响这些技能。
