Van Scoy Lauren Jodi, Watson-Martin Elizabeth, Bohr Tiffany A, Levi Benjamin H, Green Michael J
1 Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA.
2 Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Am J Hosp Palliat Care. 2018 Apr;35(4):592-600. doi: 10.1177/1049909117723619. Epub 2017 Aug 7.
Discussing end-of-life issues with patients is an essential role for chaplains. Few tools are available to help chaplains-in-training develop end-of-life communication skills.
This study aimed to determine whether playing an end-of-life conversation game increases the confidence for chaplain-in-trainings to discuss end-of-life issues with patients.
We used a convergent mixed methods design. Chaplains-in-training played the end-of-life conversation game twice over 2 weeks. For each game, pre- and postgame questionnaires measured confidence discussing end-of-life issues with patients and emotional affect. Between games, chaplains-in-training discussed end-of-life issues with an inpatient. One week after game 2, chaplains-in-training were individually interviewed. Quantitative data were analyzed using descriptive statistics and Wilcoxon rank-sum t tests. Content analysis identified interview themes. Quantitative and qualitative data sets were then integrated using a joint display.
Twenty-three chaplains-in-training (52% female; 87% Caucasian; 70% were in year 1 of training) completed the study. Confidence scores (scale: 15-75; 75 = very confident) increased significantly after each game, increasing by 10.0 points from pregame 1 to postgame 2 ( P < .001). Positive affect subscale scores also increased significantly after each game, and shyness subscale scores decreased significantly after each game. Content analysis found that chaplains-in-training found the game to be a positive, useful experience and reported that playing twice was beneficial (not redundant).
Mixed methods analysis suggest that an end-of-life conversation game is a useful tool that can increase chaplain-in-trainings' confidence for initiating end-of-life discussions with patients. A larger sample size is needed to confirm these findings.
与患者讨论临终问题是牧师的一项重要职责。目前几乎没有工具可帮助实习牧师培养临终沟通技巧。
本研究旨在确定玩临终对话游戏是否能增强实习牧师与患者讨论临终问题的信心。
我们采用了收敛性混合方法设计。实习牧师在两周内玩两次临终对话游戏。对于每次游戏，游戏前后的问卷测量了与患者讨论临终问题的信心和情绪影响。在两次游戏之间，实习牧师与一名住院患者讨论临终问题。在游戏2结束一周后，对实习牧师进行单独访谈。定量数据采用描述性统计和Wilcoxon秩和t检验进行分析。内容分析确定访谈主题。然后使用联合展示将定量和定性数据集整合起来。
23名实习牧师（52%为女性；87%为白种人；70%处于培训的第一年）完成了研究。信心得分（范围：15 - 75；75 = 非常自信）在每次游戏后显著增加，从游戏1前到游戏2后增加了10.0分（P <.001）。每次游戏后积极影响子量表得分也显著增加，羞怯子量表得分每次游戏后显著下降。内容分析发现，实习牧师认为该游戏是一次积极、有用的经历，并报告玩两次是有益的（并非多余）。
混合方法分析表明，临终对话游戏是一种有用的工具，可以增强实习牧师与患者展开临终讨论的信心。需要更大的样本量来证实这些发现。
