Mathew Rammya, Weil Anna, Sleeman Katherine E, Bristowe Katherine, Shukla Praphull, Schiff Rebekah, Flanders Lucy, Leonard Pauline, Minton Ollie, Wakefield Dominique, St John Kimberley, Carey Irene
Wembley Park Drive Medical Centre and Islington GP Federation, Wembley, UK.
North London Hospice and Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK.
Future Healthc J. 2019 Jun;6(2):129-136. doi: 10.7861/futurehosp.6-2-129.
Junior doctors describe a need for greater support and training in end of life care (EoLC) communication skills. The Second Conversation project was designed by a multi-professional steering group as a workplace based training intervention for junior doctors to improve their skills and confidence in undertaking EoLC conversations. Qualitative interviews were carried out with 11 junior doctors and five senior doctors across two sites who took part in, or facilitated, a 'second conversation'. This is a three-step training intervention that involves 1) observation - the junior doctor observes an EoLC conversation between a senior doctor and patient/caregiver; 2) direct experience - the junior doctor undertakes a follow-up second conversation with the patient/caregiver; and 3) reflection - the junior doctor discusses and reflects on the experience with a senior colleague. Interviews were analysed using framework analysis and findings informed iterative changes to the intervention and its implementation using 'Plan, Do, Study, Act' cycles. Benefits that were identified included the flexibility of the intervention and its positive impact on the confidence and skills of junior doctors. The Second Conversation was felt to be of most value to newly qualified doctors and worked well on wards where length of stay was longer and EoLC conversations frequently happen. Further evaluation and exploration of patient and caregiver experiences is required.
初级医生表示，他们需要在临终关怀（EoLC）沟通技巧方面获得更多支持和培训。“第二次对话”项目由一个多专业指导小组设计，是一项针对初级医生的基于工作场所的培训干预措施，旨在提高他们进行临终关怀对话的技能和信心。对来自两个地点的11名初级医生和5名高级医生进行了定性访谈，他们参与或协助进行了一次“第二次对话”。这是一个分三步的培训干预措施，包括：1）观察——初级医生观察高级医生与患者/护理人员之间的临终关怀对话；2）直接体验——初级医生与患者/护理人员进行后续的第二次对话；3）反思——初级医生与一位资深同事讨论并反思这次经历。使用框架分析法对访谈进行了分析，研究结果为使用“计划、执行、研究、行动”循环对干预措施及其实施进行迭代改进提供了依据。确定的益处包括干预措施的灵活性及其对初级医生信心和技能的积极影响。“第二次对话”被认为对新获得资格的医生最有价值，在住院时间较长且经常进行临终关怀对话的病房中效果良好。需要对患者和护理人员的体验进行进一步评估和探索。
