Bergman Jonathan, Lorenz Karl A, Ballon-Landa Eric, Kwan Lorna, Lerman Steven E, Saigal Christopher S, Bennett Carol J, Litwin Mark S
1 Department of Urology, David Geffen School of Medicine at UCLA , Los Angeles, California.
J Palliat Med. 2015 May;18(5):415-20. doi: 10.1089/jpm.2014.0349. Epub 2015 Mar 6.
We built a web-based, interactive, self-directed learning module about end-of-life care.
The study objective was to develop an online module about end-of-life care targeted at surgeons, and to assess the effect of the module on attitudes towards and knowledge about end-of-life care.
Informed by a panel of experts in supportive care and educational assessment, we developed an instrument that required approximately 15 minutes to complete. The module targets surgeons, but is applicable to other practitioners as well. We recruited general surgeons, surgical subspecialists, and medical practitioners and subspecialists from UCLA and the GLA-VA (N=114). We compared pre- and post-intervention scores for attitude and knowledge, then used ANOVA to compare the pre- and postmodule means for each level of the covariate. We performed bivariable analyses to assess the association of subject characteristic and change in score over time. We ran separate analyses to assess baseline and change scores based on the covariates we had selected a priori.
Subjects improved meaningfully in all five domains of attitude and in each of the six knowledge items. Individuals younger than 30 years of age had the greatest change in attitudes about addressing pain, addressing end-of-life goals, and being actively involved as death approached; they also had the most marked improvement in total knowledge score. Having a family member die of cancer within the last five years or a personal experience with palliative care or hospice were associated with higher change scores.
A web-based education module improved surgical and medical provider attitudes and knowledge about end-of-life care.
我们构建了一个基于网络的、交互式的、自主学习的临终关怀学习模块。
本研究的目的是开发一个针对外科医生的在线临终关怀模块，并评估该模块对临终关怀态度和知识的影响。
在支持性护理和教育评估专家小组的指导下，我们开发了一种大约需要15分钟完成的工具。该模块针对外科医生，但也适用于其他从业者。我们招募了来自加州大学洛杉矶分校和大洛杉矶地区退伍军人事务医疗系统的普通外科医生、外科亚专科医生以及医学从业者和亚专科医生（N = 114）。我们比较了干预前后的态度和知识得分，然后使用方差分析比较每个协变量水平下模块前后的均值。我们进行双变量分析以评估受试者特征与随时间变化的得分之间的关联。我们根据事先选择的协变量进行单独分析，以评估基线和变化得分。
受试者在态度的所有五个领域以及六个知识项目中的每一项都有显著改善。年龄小于30岁的个体在处理疼痛、确定临终目标以及在死亡临近时积极参与方面的态度变化最大；他们的总知识得分也有最显著的提高。在过去五年中有家庭成员死于癌症或有姑息治疗或临终关怀的个人经历与更高的变化得分相关。
一个基于网络的教育模块改善了外科和医疗服务提供者对临终关怀的态度和知识。
