Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise center for Palliative Care, Van der Boechorststraat 7, Amsterdam, the Netherlands.
Leiden University Medical Center, Department of Public Health and Primary Care, Albinusdreef 2, Leiden, the Netherlands; Radboud University Medical Center, Department of Primary and Community Care, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
Int J Nurs Stud. 2019 Apr;92:135-143. doi: 10.1016/j.ijnurstu.2018.09.019. Epub 2019 Jan 30.
An important part of palliative care is discussing preferences at end of life, however such conversations may not often occur. Care staff with greater self-efficacy towards end-of-life communication are probably more likely to have such discussions, however, there is a lack of research on self-efficacy towards end-of-life discussions among long-term care staff in Europe and related factors.
Firstly, to describe and compare the self-efficacy level of long-term care staff regarding end-of-life communication across six countries; secondly, to analyse characteristics of staff and facilities which are associated to self-efficacy towards end-of-life communication.
Cross-sectional survey.
Long-term care facilities in Belgium, England, Finland, Italy, the Netherlands and Poland (n = 290).
Nurses and care assistants (n = 1680) completed a self-efficacy scale and were included in the analyses.
Care staff rated their self-efficacy (confidence in their own ability) on a scale of 0 (cannot do at all) to 7 -(certain can do) of the 8-item communication subscale of the Self-efficacy in End-of-Life Care survey. Staff characteristics included age, gender, professional role, education level, training in palliative care and years working in direct care. Facility characteristics included facility type and availability of palliative care guidelines, palliative care team and palliative care advice. Analyses were conducted using Generalized Estimating Equations, to account for clustering of data at facility level.
Thde proportion of staff with a mean self-efficacy score >5 was highest in the Netherlands (76.4%), ranged between 55.9% and 60.0% in Belgium, Poland, England and Finland and was lowest in Italy (29.6%). Higher levels of self-efficacy (>5) were associated with: staff over 50 years of age (OR 1.86 95% CI[1.30-2.65]); nurses (compared to care assistants) (1.75 [1.20-2.54]); completion of higher secondary or tertiary education (respectively 2.22 [1.53-3.21] and 3.11 [2.05-4.71]; formal palliative care training (1.71 [1.32-2.21]); working in direct care for over 10 years (1.53 [1.14-2.05]); working in a facility with care provided by onsite nurses and care assistants and offsite physicians (1.86 [1.30-2.65]); and working in a facility where guidelines for palliative care were available (1.39 [1.03-1.88]).
Self-efficacy towards end-of-life communication was most often low in Italy and most often high in the Netherlands. In all countries, low self-efficacy was found relatively often for discussion of prognosis. Palliative care education and guidelines for palliative care could improve the self-efficacy of care staff.
姑息治疗的一个重要部分是讨论生命末期的偏好，但这种对话并不经常发生。自我效能感较高的医护人员可能更有可能进行此类讨论，但目前在欧洲和相关因素方面，长期护理人员对临终讨论的自我效能感研究还很缺乏。
首先，描述并比较六个国家长期护理人员在临终沟通方面的自我效能感水平；其次，分析与临终沟通自我效能感相关的员工和设施特征。
横断面调查。
比利时、英国、芬兰、意大利、荷兰和波兰的长期护理机构（n=290）。
护士和护理助理（n=1680）完成了自我效能感量表，并被纳入分析。
护理人员在 0（完全不能）到 7（肯定能）的范围内对 8 项临终关怀沟通量表的沟通子量表进行自我效能感评分。员工特征包括年龄、性别、职业角色、教育程度、姑息治疗培训和直接护理工作年限。设施特征包括设施类型以及姑息治疗指南、姑息治疗团队和姑息治疗建议的可用性。使用广义估计方程进行分析，以考虑设施层面数据的聚类。
荷兰的员工平均自我效能感评分>5 的比例最高（76.4%），比利时、波兰、英国和芬兰的比例在 55.9%至 60.0%之间，意大利的比例最低（29.6%）。更高的自我效能感（>5）与以下因素相关：年龄在 50 岁以上的员工（OR 1.86，95%CI[1.30-2.65]）；护士（与护理助理相比）（1.75 [1.20-2.54]）；完成高中或高等教育（分别为 2.22 [1.53-3.21]和 3.11 [2.05-4.71]）；接受过姑息治疗的正规培训（1.71 [1.32-2.21]）；直接护理工作超过 10 年（1.53 [1.14-2.05]）；在设施中工作，提供现场护士和护理助理以及现场医生的护理（1.86 [1.30-2.65]）；以及在提供姑息治疗指南的设施中工作（1.39 [1.03-1.88]）。
意大利的临终沟通自我效能感往往较低，荷兰的临终沟通自我效能感往往较高。在所有国家中，对预后的讨论都常常表现出自我效能感较低。姑息治疗教育和姑息治疗指南可以提高护理人员的自我效能感。
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