关于死亡与临终的观点：一项关于住院医师对临终关怀舒适度的研究。
Perspectives on death and dying: a study of resident comfort with End-of-life care.
作者信息
Schmit Jessica M, Meyer Lynne E, Duff Jennifer M, Dai Yunfeng, Zou Fei, Close Julia L
机构信息
Department of Medicine, Division of Hematology and Oncology, University of Florida, 1600 SW Archer Rd, 32610, Gainesville, FL, USA.
College of Medicine, Office of Graduate Medical Education, University of Florida, Gainesville, FL, USA.
出版信息
BMC Med Educ. 2016 Nov 21;16(1):297. doi: 10.1186/s12909-016-0819-6.
BACKGROUND
Despite the benefits to early palliative care in the treatment of terminal illness, barriers to timely hospice referrals exist. Physicians who are more comfortable having end-of-life (EOL) conversations are more likely to refer to hospice. However, very little is known about what factors influence comfort with EOL care.
METHODS
An anonymous survey was sent to all the residents and fellows at a single institution. Self-reported education, experience and comfort with EOL care was assessed. Using multivariate logistic regression analysis, variables that influenced comfort with EOL conversations were analyzed.
RESULTS
Most residents (88.1%) reported little to no classroom training on EOL care during residency. EOL conversations during residency were frequent (50.6% reported > 10) and mostly unsupervised (61.9%). In contrast, EOL conversations during medical school were infrequent (3.7% reported >10) and mostly supervised (78.6%). Most (54.3%) reported little to no classroom training on EOL care during medical school. Physicians that reported receiving education on EOL conversations during residency and those who had frequent EOL conversations during residency had significantly higher comfort levels having EOL conversations (p = 0.017 and p = 0.003, respectively). Likewise, residents that felt adequately prepared to have EOL conversations when graduating from medical school were more likely to feel comfortable (p = 0.030).
CONCLUSIONS
Most residents had inadequate education in EOL conversation skills during medical school and residency. Despite the lack of training, EOL conversations during residency are common and often unsupervised. Those who reported more classroom training during residency on EOL skills had greater comfort with EOL conversations. Training programs should provide palliative care education to all physicians during residency and fellowship, especially for those specialties that are most likely to encounter patients with advanced terminal disease.
背景
尽管早期姑息治疗对晚期疾病的治疗有益，但及时转诊至临终关怀机构仍存在障碍。更愿意进行临终（EOL）谈话的医生更有可能转诊至临终关怀机构。然而，对于影响EOL护理舒适度的因素知之甚少。
方法
向一家机构的所有住院医师和研究员发送了一份匿名调查问卷。评估自我报告的关于EOL护理的教育、经验和舒适度。使用多因素逻辑回归分析，分析影响EOL谈话舒适度的变量。
结果
大多数住院医师（88.1%）报告在住院期间很少或没有接受过关于EOL护理的课堂培训。住院期间的EOL谈话很频繁（50.6%报告>10次），且大多无人监督（61.9%）。相比之下，医学院期间的EOL谈话很少（3.7%报告>10次），且大多有人监督（78.6%）。大多数（54.3%）报告在医学院期间很少或没有接受过关于EOL护理的课堂培训。报告在住院期间接受过EOL谈话教育的医生以及在住院期间有频繁EOL谈话的医生在进行EOL谈话时的舒适度明显更高（分别为p = 0.017和p = 0.003）。同样，从医学院毕业时感觉为进行EOL谈话做好充分准备的住院医师更有可能感到舒适（p = 0.030）。
结论
大多数住院医师在医学院和住院期间对EOL谈话技能的教育不足。尽管缺乏培训，但住院期间的EOL谈话很常见且往往无人监督。那些报告在住院期间接受过更多EOL技能课堂培训的人对EOL谈话更有信心。培训项目应在住院医师和研究员培训期间为所有医生提供姑息治疗教育，尤其是对于那些最有可能遇到晚期绝症患者的专科。
Zotero 插件