Division of Geriatrics and Palliative Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Center for Trauma and Critical Care, Department of Surgery, George Washington University Hospital, Washington, DC, USA.
J Palliat Med. 2021 May;24(5):668-672. doi: 10.1089/jpm.2020.0378. Epub 2020 Sep 22.
In 2017, the American College of Surgeons' Trauma Quality Improvement Program adopted a Palliative Care Best Practices Guidelines that calls for early palliative care for hospitalized injured patients. To develop an educational intervention to address the palliative needs of injured patients. Palliative faculty presented a three-part monthly lecture series focused on core primary palliative skills, including the components of palliative care; conducting family conferences; communication skills for complex medical decision making; pain management; and, end-of-life planning. Additionally a palliative provider joined trauma team rounds every other week to highlight opportunities for enhanced palliative assessments, identify appropriate consults, and provide just-in-time teaching. Urban, level-1 trauma center. Surgical residents completed a survey at the beginning and end of the academic year, during which the intervention took place. All survey questions were answered with a 5-point Likert scale. Rate of palliative care consultation was also tracked. There were statistically significant perceived improvements in goals-of-care discussions (initial discussion-4.30 vs. 3.52, = 0.4; follow-up discussion-3.89 vs. 3.05, = 0.021) and documentation (3.89 vs. 2.9, = 0.032), incorporation of patient preferences into decision making (4.20 vs. 3.43, = 0.04), discussion of palliative needs during rounds (4.30 vs. 2.81; < 0.001) and care transitions (3.90 vs. 3.05, = 0.008), respect for decisions to forgo life-sustaining treatments (4.40 vs. 3.52, = 0.004), and identification of advance directives (4.11 vs. 3.05, = 0.002) and surrogate decision maker (4.44 vs. 3.60, = 0.015). The overall rate of palliative specialist consultation also increased (8.4% vs. 16.1%, < 0.001). Embedding primary palliative education into usual didactic and rounding time for an inpatient trauma team is an effective way to help residents develop palliative skills and foster culture change. Educational partnerships such as this may serve as an example to other trauma programs.
2017 年，美国外科医师学院创伤质量改进计划采用了姑息治疗最佳实践指南，呼吁对住院受伤患者进行早期姑息治疗。为了制定一项教育干预措施来满足受伤患者的姑息治疗需求，姑息治疗教师每两个月进行一次为期三部分的月度讲座系列，重点介绍姑息治疗的核心初级技能，包括姑息治疗的组成部分；进行家庭会议；复杂医疗决策的沟通技巧；疼痛管理；以及临终规划。此外，每周两次有一名姑息治疗提供者加入创伤团队查房，以突出增强姑息评估的机会，确定适当的咨询，并提供即时教学。城市一级创伤中心。外科住院医师在学术年开始和结束时完成了一项调查，在此期间进行了干预。所有调查问题均采用 5 分李克特量表回答。姑息治疗咨询的比率也被跟踪。在目标关怀讨论（初始讨论 4.30 与 3.52， = 0.4；随访讨论 3.89 与 3.05， = 0.021）和记录（3.89 与 2.9， = 0.032）、将患者偏好纳入决策（4.20 与 3.43， = 0.04）、在查房期间讨论姑息治疗需求（4.30 与 2.81； < 0.001）和护理过渡（3.90 与 3.05， = 0.008）、尊重放弃维持生命治疗的决定（4.40 与 3.52， = 0.004）以及确定预先指示（4.11 与 3.05， = 0.002）和替代决策人（4.11 与 3.05， = 0.002）和替代决策人（4.44 与 3.60， = 0.015）方面，住院创伤团队的初级姑息教育被嵌入到常规教学和查房时间中，这是帮助住院医师发展姑息治疗技能和促进文化变革的有效方法。这种教育伙伴关系可能成为其他创伤项目的一个范例。
