Brighton Lisa Jane, Selman Lucy Ellen, Gough Nicholas, Nadicksbernd J J, Bristowe Katherine, Millington-Sanders Catherine, Koffman Jonathan
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK.
BMJ Support Palliat Care. 2018 Mar;8(1):45-48. doi: 10.1136/bmjspcare-2017-001447. Epub 2017 Nov 8.
Evidence-based communication skills training for health and social care professionals is essential to improve the care of seriously ill patients and their families. We aimed to evaluate the self-reported impact of 'Difficult Conversations', a multidisciplinary half-day interactive workshop, and gain feedback to inform future development and evaluation.
Service evaluation using questionnaire data collected before and immediately after workshops from February 2015 to August 2016 regarding participant self-assessed confidence, knowledge and skills. Qualitative free-text comments provided feedback about the workshop and were subjected to content analysis.
Of 886 workshop participants, 655 completed baseline questionnaires and 714 postworkshop questionnaires; 550 were matched pairs. Participants were qualified or trainee general practitioners (34%), community nurses and care coordinators (32%), social care professionals (7%), care home staff (6%), advanced practice/specialist nurses (5%), care workers (5%) and allied health professionals (3%). All groups demonstrated significant increases in mean self-assessed confidence (2.46, 95% CI 2.41 to 2.51; to 3.20, 95% CI 3.17 to 3.24; P<0.001), knowledge (2.22, 95% CI 2.17 to 2.27; to 3.18, 95% CI 3.14 to 3.22; P<0.001) and skills (2.37, 95% CI 2.32 to 2.42; to 3.09, 95% CI 3.05 to 3.12; P<0.001). Qualitative findings showed participants valued role play, the communication framework acronym and opportunities for discussion. They commended workshop facilitators' skills, the safe atmosphere and interprofessional learning. Suggested improvements included more prepared role play and greater coverage of the taught topics.
'Difficult Conversations' workshops were associated with improvements in participants' self-assessed confidence, knowledge, and skills. Our findings identify workshop characteristics that are acceptable to multidisciplinary trainees. Further testing is warranted to determine effectiveness and accurately identify workshop components leading to change.
为卫生和社会护理专业人员提供基于证据的沟通技巧培训对于改善重症患者及其家属的护理至关重要。我们旨在评估为期半天的多学科互动研讨会“艰难对话”的自我报告影响,并获取反馈以指导未来的发展与评估。
利用2015年2月至2016年8月期间在研讨会前后立即收集的问卷数据进行服务评估,内容涉及参与者的自我评估信心、知识和技能。定性的自由文本评论提供了关于研讨会的反馈,并进行了内容分析。
在886名研讨会参与者中,655人完成了基线问卷,714人完成了研讨会后问卷;550人是配对组。参与者包括合格或实习全科医生(34%)、社区护士和护理协调员(32%)、社会护理专业人员(7%)、养老院工作人员(6%)、高级实践/专科护士(5%)、护理人员(5%)和专职医疗专业人员(3%)。所有组在平均自我评估信心(2.46,95%置信区间2.41至2.51;至3.20,95%置信区间3.17至3.24;P<0.001)、知识(2.22,95%置信区间2.17至2.27;至3.18,95%置信区间3.14至3.22;P<0.001)和技能(2.37,95%置信区间2.32至2.42;至3.09,95%置信区间3.05至3.12;P<0.001)方面均有显著提高。定性研究结果表明,参与者重视角色扮演、沟通框架首字母缩写词以及讨论机会。他们称赞研讨会主持人的技能、安全的氛围和跨专业学习。建议的改进包括更有准备的角色扮演以及对所教授主题的更广泛覆盖。
“艰难对话”研讨会与参与者自我评估的信心、知识和技能的提高相关。我们的研究结果确定了多学科受训人员可接受的研讨会特征。有必要进行进一步测试以确定有效性并准确识别导致变化的研讨会组成部分。