School of Health Sciences, Innovation, Implementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.
Department of Thoracic Medicine, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
BMC Med Educ. 2020 Mar 30;20(1):90. doi: 10.1186/s12909-020-02006-7.
Clinicians and people living with chronic breathlessness have expressed a need to better understand and manage this symptom. The aim of this study was to evaluate a 3-day health professional training workshop on the practical management of chronic breathlessness.
Workshop design and delivery were based on current understandings and clinical models of chronic breathlessness management, principles of transformative learning, and included sessions co-designed with people living with breathlessness. Registrants were invited to complete pre and post-workshop surveys. Pre and 1-week post-workshop online questionnaires assessed familiarity and confidence about workshop objectives (0[lowest]-10[highest] visual analogue scale), attitudes and practices regarding chronic breathlessness (agreement with statements on 5-point Likert scales). Post-workshop, participants were asked to describe implementation plans and anticipated barriers. Baseline familiarity and confidence were reported as mean (SD) and change examined with paired t-tests. Pre-post attitudes and practices were summarised by frequency/percentages and change examined non-parametrically (5-point Likert scale responses) or using a McNemar test of change (binary responses).
Forty-seven of 55 registrants joined the study; 39 completed both pre and post-workshop questionnaires (35 female; 87% clinicians; median 8 years working with people with chronic breathlessness). Post-workshop, greatest gains in confidence were demonstrated for describing biopsychosocial concepts unpinning chronic breathlessness (mean change confidence = 3.2 points; 95% CI 2.7 to 4.0, p < 0.001). Respondents significantly changed their belief toward agreement that people are able to rate their breathlessness intensity on a scale (60 to 81% agreement) although only a minority strongly agreed with this statement at both time points (pre 11%, post 22%). The largest shift in attitude was toward agreement (z statistic 3.74, p < 0.001, effect size r = 0.6) that a person's experience of breathlessness should be used to guide treatment decisions (from 43 to 73% strong agreement). Participants' belief that cognitive behavioural strategies are effective for relief of breathlessness changed further toward agreement after the workshop (81 to 100%, McNemar test chi- square = 5.14, p = 0.02).
The focus of this training on biopsychosocial understandings of chronic breathlessness and involvement of people living with this symptom were valued. These features were identified as facilitators of change in fundamental attitudes and preparedness for practice.
临床医生和慢性呼吸困难患者表示需要更好地理解和管理这种症状。本研究的目的是评估一个为期 3 天的关于慢性呼吸困难管理的专业培训课程。
工作坊的设计和实施基于对慢性呼吸困难管理的现有认识和临床模式、变革学习的原则，并包括与呼吸困难患者共同设计的课程。邀请注册者在参加工作坊前后完成调查。参加者在参加工作坊前和 1 周后进行在线问卷调查，评估对工作坊目标的熟悉程度和信心（0[最低]-10[最高]视觉模拟量表）、对慢性呼吸困难的态度和实践（对 5 分李克特量表上的陈述的同意程度）。工作坊结束后，参与者被要求描述实施计划和预期障碍。报告基线熟悉程度和信心的平均值（标准差），并使用配对 t 检验检查变化。通过频率/百分比总结工作坊前后的态度和实践，使用非参数检验（5 分李克特量表的回答）或麦克内尔变化检验（二分类回答）检查变化。
55 名注册者中的 47 名参加了研究；39 名完成了工作坊前后的问卷调查（35 名女性；87%为临床医生；中位工作经验 8 年，与慢性呼吸困难患者合作）。工作坊后，在描述慢性呼吸困难背后的生物心理社会概念方面，信心的增长最大（平均信心变化为 3.2 分；95%置信区间 2.7 至 4.0，p<0.001）。参与者对以下陈述的信念发生了显著变化，即人们能够在量表上评估自己的呼吸困难强度（60%至 81%的同意），尽管只有少数人在两个时间点都强烈同意这一观点（前为 11%，后为 22%）。态度的最大转变是同意（z 统计量 3.74，p<0.001，效应量 r=0.6），即一个人的呼吸困难体验应用于指导治疗决策（从 43%到 73%强烈同意）。参与者对认知行为策略缓解呼吸困难的有效性的信念在工作坊后进一步趋于一致（81%到 100%，麦克内尔检验卡方=5.14，p=0.02）。
培训的重点是慢性呼吸困难的生物心理社会理解以及患者的参与，这两点受到了重视。这些特点被确定为改变基本态度和为实践做好准备的促进因素。
