Brock Katharine E, Cohen Harvey J, Sourkes Barbara M, Good Julie J, Halamek Louis P
1 Division of Pediatric Hematology/Oncology, Emory University , Atlanta, Georgia .
2 Aflac Cancer & Blood Disorders Center , Children's Healthcare of Atlanta, Atlanta, Georgia .
J Palliat Med. 2017 Oct;20(10):1074-1084. doi: 10.1089/jpm.2016.0556. Epub 2017 Apr 24.
Pediatric fellows receive little palliative care (PC) education and have few opportunities to practice communication skills.
In this pilot study, we assessed (1) the relative effectiveness of simulation-based versus didactic education, (2) communication skill retention, and (3) effect on PC consultation rates.
Thirty-five pediatric fellows in cardiology, critical care, hematology/oncology, and neonatology at two institutions enrolled: 17 in the intervention (simulation-based) group (single institution) and 18 in the control (didactic education) group (second institution). Intervention group participants participated in a two-day program over three months (three simulations and videotaped PC panel). Control group participants received written education designed to be similar in content and time.
(1) Self-assessment questionnaires were completed at baseline, post-intervention and three months; mean between-group differences for each outcome measure were assessed. (2) External reviewers rated simulation-group encounters on nine communication domains. Within-group changes over time were assessed. (3) The simulation-based site's PC consultations were compared in the six months pre- and post-intervention.
Compared to the control group, participants in the intervention group improved in self-efficacy (p = 0.003) and perceived adequacy of medical education (p < 0.001), but not knowledge (p = 0.20). Reviewers noted nonsustained improvement in four domains: relationship building (p = 0.01), opening discussion (p = 0.03), gathering information (p = 0.01), and communicating accurate information (p = 0.04). PC consultation rate increased 64%, an improvement when normalized to average daily census (p = 0.04).
This simulation-based curriculum is an effective method for improving PC comfort, education, and consults. More frequent practice is likely needed to lead to sustained improvements in communication competence.
儿科住院医师接受的姑息治疗（PC）教育很少，且几乎没有机会练习沟通技巧。
在这项试点研究中，我们评估了（1）基于模拟的教育与理论教育的相对有效性，（2）沟通技巧的保持情况，以及（3）对PC会诊率的影响。
来自两家机构的35名从事心脏病学、重症监护、血液学/肿瘤学和新生儿学的儿科住院医师参与研究：17名在干预（基于模拟）组（单一机构），18名在对照组（理论教育）组（第二家机构）。干预组参与者在三个月内参加了为期两天的项目（三次模拟和PC小组录像）。对照组参与者接受了内容和时长相似的书面教育。
（1）在基线、干预后和三个月时完成自我评估问卷；评估每个结果指标的组间平均差异。（2）外部评审员对模拟组在九个沟通领域的交流进行评分。评估组内随时间的变化。（3）比较基于模拟的机构在干预前后六个月内的PC会诊情况。
与对照组相比，干预组参与者的自我效能感（p = 0.003）和医学教育感知充足度（p < 0.001）有所提高，但知识水平（p = 0.20）没有提高。评审员指出在四个领域的改善未持续：建立关系（p = 0.01）、开启讨论（p = 0.03）、收集信息（p = 0.01）和传达准确信息（p = 0.04）。PC会诊率提高了64%，按日均普查人数标准化后有所改善（p = 0.04）。
这种基于模拟的课程是提高PC舒适度、教育水平和会诊率的有效方法。可能需要更频繁的练习才能使沟通能力持续提高。
