1King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
Palliat Med. 2014 Apr;28(4):360-6. doi: 10.1177/0269216313510342. Epub 2013 Nov 7.
In recent years, the End-Stage Kidney Disease population has increased and is ever more frail, elderly and co-morbid. A care-focused approach needs to be incorporated alongside the disease focus, to identify those who are deteriorating and improve communication about preferences and future care. Yet many renal professionals feel unprepared for such discussions.
To develop and pilot a REnal specific Advanced Communication Training (REACT) programme to address the needs of End-Stage Kidney Disease patients and renal professionals.
Two-part study: (1) development of the REnal specific Advanced Communication Training programme informed by multi-professional focus group and patient survey and (2) piloting of the programme.
SETTING/PARTICIPANTS: The REnal specific Advanced Communication Training programme was piloted with 16 participants (9 renal nurses/health-care assistants and 7 renal consultants) in two UK teaching hospitals.
The focus group identified the need for better information about end-of-life phase, improved awareness of patient perspectives, skills to manage challenging discussions, 'hands on' practice in a safe environment and follow-up to discuss experiences. The patient survey demonstrated a need to improve communication about concerns, treatment plans and decisions. The developed REnal specific Advanced Communication Training programme was acceptable and feasible and was associated with a non-significant increase in confidence in communicating about end-of-life issues (pre-training: 6.6/10, 95% confidence interval: 5.7-7.4; post-training: 6.9/10, 95% confidence interval: 6.1-7.7, unpaired t-test - p = 0.56), maintained at 3 months.
There is a need to improve end-of-life care for End-Stage Kidney Disease patients, to enable them to make informed decisions about future care. Challenges include prioritising communication training among service providers.
近年来，终末期肾病患者人数不断增加，且患者身体愈发虚弱，年龄也越来越大，合并症也越来越多。在关注疾病的同时，需要采取关注患者的护理方式，以确定哪些患者病情正在恶化，并改善对偏好和未来护理的沟通。然而，许多肾脏专业人员觉得自己没有准备好进行此类讨论。
开发和试点肾脏特定高级沟通培训（REACT）计划，以满足终末期肾病患者和肾脏专业人员的需求。
两部分研究：（1）根据多专业焦点小组和患者调查开发肾脏特定高级沟通培训计划，（2）试点该计划。
地点/参与者：该肾脏特定高级沟通培训计划在英国两家教学医院试点，共有 16 名参与者（9 名肾脏护士/医疗保健助理和 7 名肾脏顾问）参加。
焦点小组确定了需要更好地了解终末期阶段的信息，提高对患者观点的认识，掌握管理挑战性讨论的技能，在安全的环境中进行“实践”，并跟进讨论经验。患者调查表明需要改善对关注问题、治疗计划和决策的沟通。开发的肾脏特定高级沟通培训计划是可以接受和可行的，与沟通临终问题的信心显著增加无关（培训前：6.6/10，95%置信区间：5.7-7.4；培训后：6.9/10，95%置信区间：6.1-7.7，配对 t 检验-p=0.56），并在 3 个月时保持不变。
需要改善终末期肾病患者的临终关怀，使他们能够就未来的护理做出明智的决定。挑战包括在服务提供者中优先考虑沟通培训。
