Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Berman Institute of Bioethics, Baltimore, Maryland, USA.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Pain Symptom Manage. 2020 Nov;60(5):959-967. doi: 10.1016/j.jpainsymman.2020.06.005. Epub 2020 Jun 12.
Children with chronic critical illness (CCI) have repeated and prolonged hospitalizations. Discrete communication challenges characterize their inpatient care.
Develop, implement, and evaluate a communication training for inpatient clinicians managing pediatric CCI.
A one-day communication training for interdisciplinary clinicians, incorporating didactic sessions and simulated family and interdisciplinary team meetings.
Learners had an average of 11 years' clinical experience. About 34% lacked prior communication training relevant to pediatric CCI. Mean baseline competence across communication skills was 2.6 (range 2.4-3.2), corresponding to less than somewhat prepared; after the training, this increased to a mean of 4.0 (range 3.5-4.5), corresponding to well prepared. Skills with greatest improvement included conducting a family meeting, delivering bad news, discussing stopping intensive care, and end-of-life communication. After one month, perceived competence was sustained for seven of 10 skills; for remaining skills, perceived competence scores decreased by 0.1-0.2. About 100% of learners would recommend the training to colleagues; 89% advocated it for all clinicians caring for children with CCI.
Interdisciplinary communication training regarding long stay patients is feasible and valued by novice and seasoned clinicians. The novel integration of intrateam communication skills alongside team-family skills reflects the reality that the care of children with CCI challenges clinicians to communicate well with each other and families. Teaching interdisciplinary teams to share communication skills has the potential to overcome reported limitations of existing inpatient discussions, which can be dominated by one or two physicians and lack contributions from diverse team members.
患有慢性危重病（CCI）的儿童需要反复和长时间住院。他们的住院护理存在明显的沟通挑战。
为管理儿科 CCI 的住院临床医生开发、实施和评估沟通培训。
为跨学科临床医生提供为期一天的沟通培训，包括讲座和模拟家庭和跨学科团队会议。
学习者平均具有 11 年的临床经验。约 34%的人缺乏与儿科 CCI 相关的先前沟通培训。沟通技能的平均基线能力为 2.6（范围为 2.4-3.2），对应于准备不足；培训后，这一数字增加到 4.0（范围为 3.5-4.5），对应于准备充分。技能提高最大的包括主持家庭会议、传递坏消息、讨论停止重症监护和生命末期沟通。一个月后，7 项技能中有 10 项的感知能力得到维持；对于其余技能，感知能力评分下降了 0.1-0.2。约 100%的学习者会向同事推荐培训；89%的人主张为所有照顾慢性危重病儿童的临床医生提供培训。
针对长期住院患者的跨学科沟通培训是可行的，受到新手和经验丰富的临床医生的重视。在团队-家庭技能之外，同时教授团队内部沟通技能，反映了这样一个现实，即照顾患有 CCI 的儿童需要临床医生与彼此和家属进行良好的沟通，这对他们提出了挑战。教授跨学科团队分享沟通技能有可能克服现有住院讨论中存在的报告限制，这些讨论可能由一两个医生主导，缺乏来自不同团队成员的贡献。
