Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia.
Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia.
Patient Educ Couns. 2018 Jun;101(6):983-994. doi: 10.1016/j.pec.2018.01.020. Epub 2018 Feb 2.
Family caregivers can, at times, add complexity to clinical encounters. Difficult family caregivers and dynamics may: derail consultation communication, reduce patient autonomy, and compromise effective clinical care. A paucity of practical strategies guiding effective clinician-family communication exists. This study aimed to develop and evaluate the first comprehensive, evidence-based guidelines (the TRIO guidelines) for oncology physicians and nurses to better manage several complex/challenging situations involving family members.
TRIO Guidelines were based on a comprehensive review of literature, relevant guidelines, and feedback from an expert advisory group (n = 10). Draft guidelines underwent two rounds of evaluation via an online Delphi consensus process involving international experts (n = 35).
Guidelines incorporate topic areas, strategies, and sub-strategies on managing challenging family involvement (7 topics). Example wording, behaviours and level of evidence are provided.
Challenging triadic interactions require skillful navigation, and the TRIO Guidelines provide clear, specific, and evidence-based strategies for clinicians to utilise in these potentially stressful encounters. Training based on these guidelines may improve both patient care and clinician confidence.
Implementation of these guidelines into medical/nursing curricula and as a component of continuing professional development programs will likely be highly beneficial.
家庭护理人员有时会给临床诊疗带来复杂性。难缠的家庭护理人员及其行为模式可能会：破坏医患沟通，降低患者自主权，并影响有效的临床护理。目前，指导临床医生与患者家庭进行有效沟通的实用策略相对较少。本研究旨在制定并评估针对肿瘤医生和护士的首个全面、基于循证的指南（TRIO 指南），以更好地管理涉及家庭成员的几种复杂/具有挑战性的情况。
TRIO 指南基于对文献、相关指南的全面审查，以及来自专家咨询小组（n=10）的反馈。草案指南通过两轮在线德尔菲共识程序（n=35）进行了评估。
指南涵盖了管理具有挑战性的家庭参与的主题领域、策略和子策略（7 个主题）。提供了示例措辞、行为和证据水平。
具有挑战性的三方互动需要技巧性的应对，TRIO 指南为临床医生在这些潜在压力下的互动提供了明确、具体和基于证据的策略。基于这些指南的培训可能会提高患者护理质量和临床医生的信心。
将这些指南纳入医学/护理课程，并作为继续专业发展计划的一部分，可能会非常有益。
