Katz Naomi T, Sacks Bronwyn H, Hynson Jenny L, Heywood Melissa, Williams Molly, Sokol Jenni
Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, Victoria, Australia.
Simulation Program, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2020 Dec;56(12):1898-1905. doi: 10.1111/jpc.15074. Epub 2020 Aug 19.
To assess clinicians' experience, attitudes and confidence with advance care planning (ACP) at a quaternary paediatric referral centre using a learning-needs survey, and then apply this information to develop and examine the feasibility of simulation-based education for this topic.
An electronic learning-needs survey was distributed to medical, nursing and allied health clinicians from departments who provide primary care for children with life-limiting conditions. Results were incorporated into the design of a simulation-based education session which was piloted with the Royal Children's Hospital Oncology Department.
A total of 157 learning-needs surveys were included in analysis, and included quantitative and qualitative responses from nursing, allied health, senior and junior medical staff from intensive care, general and subspecialty medical teams. Most (75.0%) participants had participated in ACP discussions previously. Only 40.1% of participants felt confident to assess appropriate timing of, and 45.2% felt adequately prepared to participate in ACP discussions. Barriers identified were both clinician and patient/parent related, including clinicians not knowing when to address issues (43.9%) or what to say (21.0%). Participants indicated that ACP discussions are most frequently initiated when death is clearly imminent. Following a pilot of simulation-based education with the oncology department, 90% of participants expressed confidence to participate in ACP discussions.
Barriers to paediatric ACP, including lack of clinician training, continue to contribute to delayed conversations. Simulation-based education is a valuable and feasible educational tool that can increase clinicians' understanding and confidence in this area.
通过一项学习需求调查，评估一家四级儿科转诊中心的临床医生在预立医疗计划（ACP）方面的经验、态度和信心，然后运用这些信息来开发并检验针对该主题的基于模拟的教育的可行性。
向为患有危及生命疾病的儿童提供初级护理的各科室的医学、护理和专职医疗临床医生发放了一份电子学习需求调查问卷。结果被纳入到一个基于模拟的教育课程的设计中，该课程在皇家儿童医院肿瘤科进行了试点。
共有157份学习需求调查问卷纳入分析，包括来自重症监护、普通和专科医疗团队的护理、专职医疗、高级和初级医务人员的定量和定性回复。大多数（75.0%）参与者此前曾参与过ACP讨论。只有40.1%的参与者认为有信心评估适当的时机，45.2%的参与者认为有充分准备参与ACP讨论。所确定的障碍既有与临床医生相关的，也有与患者/家长相关的，包括临床医生不知道何时讨论问题（43.9%）或不知道说什么（21.0%）。参与者表示，当死亡明显临近时，ACP讨论最常开始。在肿瘤科进行基于模拟的教育试点后，90%的参与者表示有信心参与ACP讨论。
儿科ACP的障碍，包括临床医生缺乏培训，继续导致讨论延迟。基于模拟的教育是一种有价值且可行的教育工具，可以增强临床医生在这方面的理解和信心。
