Frerich Gerrit, Romotzky Vanessa, Galushko Maren, Hamacher Stefanie, Perrar Klaus Maria, Doll Axel, Montag Thomas, Golla Heidrun, Strupp Julia, Kremeike Kerstin, Voltz Raymond
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany.
Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany.
Palliat Support Care. 2020 Oct;18(5):528-536. doi: 10.1017/S1478951520000097.
Patients' desire to die (DD) is rarely discussed in palliative care (PC) due to health professionals' (HPs) feeling of uncertainty. The aim of the study was to develop and evaluate a training to increase HPs' self-confidence in responding professionally to patient's DD and to assess the feasibility of this approach.
The training course was developed via focus groups and relevant literature and refined with an advisory board. An evaluation design was developed to evaluate training outcomes and to examine feasibility. To assess self-confidence, knowledge, skills, and attitudes: (1) standardized surveys were applied at T1 (before training), T2 (directly after), and T3 (3 months later), and were analyzed by descriptive and non-parametric statistics; and (2) participants' open feedback was summarized by content.
A two-day multi-disciplinary training was developed to improve self-confidence via diverse teaching methods. Twenty-four HPs from general and specialized PC were participated. Via self-rating on Likert scales at three time points, improvements were seen at T1, T2, and partly remained at T3, especially in the overall item of self-confidence in communicating with patients about their DD (means: 4.3. at T1, 5.7 at T2, and 5.9 at T3; on a 7-point scale with 1 = lowest value and 7 = highest value). Fewer improvements were found in skills (using different approaches) and attitudes (feeling less helplessness). Open feedback revealed a high appreciation for the training, especially the composition of participants, the role-play, and the overall increase of awareness of the topic.
The developed training on addressing DD meets a need and was perceived by the participants to be of added value. Future research should measure training effects with a validated instrument, including more participants, diverse participant groups, and a control group. Effects on patients should be assessed.
由于医护人员存在不确定感，姑息治疗（PC）中很少讨论患者的死亡意愿（DD）。本研究的目的是开发并评估一项培训，以增强医护人员在专业应对患者死亡意愿方面的自信心，并评估该方法的可行性。
通过焦点小组和相关文献开发培训课程，并由顾问委员会进行完善。制定了一项评估设计，以评估培训效果并检验可行性。为评估自信心、知识、技能和态度：（1）在T1（培训前）、T2（培训后立即）和T3（3个月后）应用标准化调查，并通过描述性和非参数统计进行分析；（2）对参与者的开放式反馈进行内容总结。
开发了一项为期两天的多学科培训，通过多种教学方法提高自信心。来自普通和专科姑息治疗的24名医护人员参与其中。通过在三个时间点进行李克特量表自评，在T1、T2有改善，部分改善在T3仍持续，特别是在与患者就其死亡意愿进行沟通的自信心总体项目上（均值：T1为4.3，T2为5.7，T3为5.9；7分制，1 = 最低值，7 = 最高值）。在技能（使用不同方法）和态度（感觉无助感减少）方面的改善较少。开放式反馈显示对培训高度赞赏，特别是参与者的构成、角色扮演以及对该主题认识的总体提高。
所开发的关于应对死亡意愿的培训满足了一种需求，参与者认为其具有附加价值。未来的研究应以经过验证的工具测量培训效果，包括更多参与者、不同的参与者群体和一个对照组。应评估对患者的影响。
