Wilson Paria M, Herbst Lori A, Gonzalez-Del-Rey Javier
1 Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
2 Division of Hospital Medicine, Department of Pediatrics and General Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, Cincinnati, OH, USA.
Am J Hosp Palliat Care. 2018 Nov;35(11):1439-1445. doi: 10.1177/1049909118786870. Epub 2018 Jul 15.
Caring for a child near the end of life (EOL) can be a stressful experience. Resident physicians are often the frontline providers responsible for managing symptoms, communicating difficult information, and pronouncing death, yet they often receive minimal education on EOL care.
To develop and implement an EOL curriculum and to study its impact on resident comfort and attitudes surrounding EOL care.
Kern's 6-step approach to curriculum development was used as a framework for curriculum design and implementation.
SETTING/PARTICIPANTS: Categorical and combined pediatric residents at a large quaternary care children's hospital were exposed to the curriculum.
A cross-sectional survey was distributed pre- and postimplementation of the curriculum to evaluate its impact on resident comfort and attitudes surrounding EOL care.
One-hundred twenty-six (49%) of 258 residents completed the preimplementation survey, and 65 (32%) of 201 residents completed the postimplementation survey. Over 80% of residents reported caring for a dying patient, yet less than half the residents reported receiving prior education on EOL care. Following curriculum implementation, the percentage of residents dissatisfied with their EOL education fell from 36% to 14%, while the percentage of residents satisfied with their education increased from 14% to 29%. The postimplementation survey identified that resident comfort with communication-based topics improved, and they sought additional training in symptom management.
The implementation of a longitudinal targeted multimodal EOL curriculum improved resident satisfaction with EOL education and highlighted the need for additional EOL education.
照顾濒死儿童可能是一段压力巨大的经历。住院医师常常是负责管理症状、传达棘手信息以及宣布死亡的一线医护人员，但他们接受的临终关怀教育往往极少。
开发并实施一门临终关怀课程，研究其对住院医师在临终关怀方面的舒适度及态度的影响。
采用克恩课程开发六步法作为课程设计与实施的框架。
地点/参与者：一家大型四级护理儿童医院的普通儿科住院医师和综合儿科住院医师参与了该课程。
在课程实施前后分别进行横断面调查，以评估其对住院医师在临终关怀方面的舒适度及态度的影响。
258名住院医师中有126名（49%）完成了实施前调查，201名住院医师中有65名（32%）完成了实施后调查。超过80%的住院医师报告曾照顾过濒死患者，但报告此前接受过临终关怀教育的住院医师不到一半。课程实施后，对临终关怀教育不满意的住院医师比例从36%降至14%，而对教育满意的住院医师比例从14%增至29%。实施后调查表明，住院医师在基于沟通的主题方面的舒适度有所提高，并且他们寻求在症状管理方面接受更多培训。
实施一门纵向的、有针对性的多模式临终关怀课程提高了住院医师对临终关怀教育的满意度，并凸显了进一步开展临终关怀教育的必要性。
