Chan Carmen Wing Han, Ng Nancy Hiu Yim, Chan Helen Y L, Wong Martin M H, Chow K M
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, NT, Hong Kong.
BMC Health Serv Res. 2019 Jun 7;19(1):362. doi: 10.1186/s12913-019-4192-0.
Advance care planning (ACP) is the process of ongoing communication among patients, family and health care professionals regarding what plans for future care are preferred in the event that patients become unable to make their own decisions. Clinicians play an important role in ACP as both initiators and decision coaches. However, lack of training for clinicians has frequently been reported as the reason for low involvement in ACP discussions - hence the present review evaluates the effectiveness of ACP training programs for healthcare professionals to guide the development of novel training programs for them in the future.
A literature search for intervention studies was conducted independently by two reviewers in July 2018. Participants included all healthcare professionals working with adult patients suffering from terminal illness. The primary outcomes were the professionals' knowledge of and attitudes towards ACP, and self-perceived competence in ACP conversations. The Effective Public Health Practice Project appraisal tool was used to examine the quality of the studies included.
A total of 4025 articles were identified, and ten eligible articles, covering 1081 participants, were included in the review. However, there is a lack of high quality randomized controlled trials of providing ACP training for nurses working in non-palliative care hospital settings. The overall quality of the intervention studies was moderate. All the studies included used instructional sessions in their interventions, while some contained group discussion, role-play and the use of advanced technology. The training programs increased the knowledge, attitudes towards shared decision-making, perceived communication skills, confidence, comfort and experiences concerned with discussing end-of-life (EOL) issues. Patient advocacy, job satisfaction and perceived level of adequate training for EOL care were improved. The use of 'decision aids' was rated as acceptable and clinically useful.
Training for healthcare professionals in ACP has positive effects on their knowledge, attitude and skills. The use of decision aids and advanced technology, instructional sessions with role play, training content focused on ACP communication skills and the needs and experience of patient in the ACP process, and a values-based ACP process are all those factors that made the ACP training programs effective.
预先护理计划（ACP）是患者、家属和医疗保健专业人员之间就患者无法自行做决定时对未来护理的偏好计划进行持续沟通的过程。临床医生在ACP中作为发起者和决策指导者发挥着重要作用。然而，经常有报道称临床医生缺乏培训是其参与ACP讨论程度低的原因——因此，本综述评估了针对医疗保健专业人员的ACP培训项目的有效性，以指导未来为他们开发新的培训项目。
2018年7月，两名评审员独立进行了干预研究的文献检索。参与者包括所有为成年绝症患者提供服务的医疗保健专业人员。主要结果是专业人员对ACP的知识和态度，以及在ACP对话中的自我感知能力。使用有效公共卫生实践项目评估工具来检查纳入研究的质量。
共识别出4025篇文章，本综述纳入了10篇符合条件的文章，涵盖1081名参与者。然而，缺乏针对在非姑息治疗医院环境中工作的护士进行ACP培训的高质量随机对照试验。干预研究的总体质量中等。所有纳入的研究在干预中都使用了教学课程，而一些研究包含小组讨论、角色扮演和先进技术的使用。培训项目增加了知识、对共同决策的态度、感知的沟通技巧、信心、舒适度以及与讨论临终（EOL）问题相关的经验。患者倡导、工作满意度以及对EOL护理的充分培训感知水平得到了提高。“决策辅助工具”的使用被评为可接受且具有临床实用性。
针对医疗保健专业人员的ACP培训对他们的知识、态度和技能有积极影响。决策辅助工具和先进技术的使用、带有角色扮演的教学课程、专注于ACP沟通技巧以及ACP过程中患者需求和经验的培训内容，以及基于价值观的ACP过程，都是使ACP培训项目有效的因素。
