Ko Jenny J, Ballard Mark S, Shenkier Tamara, Simon Jessica, Roze des Ordons Amanda, Fyles Gillian, Lefresne Shilo, Hawley Philippa, Chen Charlie, McKenzie Michael, Ghement Isabella, Sanders Justin J, Bernacki Rachelle, Jones Scott
Department of Medical Oncology, University of British Columbia, BC Cancer-Abbotsford, Abbotsford, British Columbia, Canada.
Department of Internal Medicine, Chilliwack General Hospital, Chilliwack, British Columbia, Canada.
Palliat Med Rep. 2020 Nov 24;1(1):280-290. doi: 10.1089/pmr.2020.0086. eCollection 2020.
The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients. We developed the SIC-Ex based on SIC and on the Royal College of Canada Medical Oncology milestones. Seven resident trainees and 10 evaluators were recruited. Each trainee conducted an SIC with a patient, which was videotaped. The evaluators watched the videos and evaluated each trainee by using the novel SIC-Ex and the reference Calgary-Cambridge guide (CCG) at months zero and three. We used Kane's validity framework to assess validity. Intra-class correlation using average SIC-Ex scores showed a moderate level of inter-evaluator agreement (range 0.523-0.822). Most evaluators rated a particular resident similar to the group average, except for one to two evaluator outliers in each domain. Test-retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators. SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.
重病诊疗谈话（SIC）是一种基于证据的框架，用于与患者就重病诊断进行沟通。我们研究的目的是开发并验证一种新型工具，即SIC评估练习（SIC-Ex），以促进对住院医师与肿瘤患者谈话的评估。我们基于SIC和加拿大皇家内科医学院肿瘤学里程碑开发了SIC-Ex。招募了7名住院医师学员和10名评估人员。每位学员与一名患者进行一次SIC，并进行录像。评估人员观看录像，并在第0个月和第3个月使用新型SIC-Ex和参考的卡尔加里-剑桥指南（CCG）对每位学员进行评估。我们使用凯恩的效度框架来评估效度。使用SIC-Ex平均得分的组内相关性显示评估人员之间的一致性处于中等水平（范围为0.523 - 0.822）。除了每个领域有一到两个评估人员的异常值外，大多数评估人员对特定住院医师的评分与组平均水平相似。重测信度显示第0个月和第3个月SIC-Ex得分之间的一致性处于中等水平。第0个月和第3个月的整体评分显示评估人员之间的相关性为中等至良好/非常好。大多数评估人员比较SIC-Ex总分和CCG得分的皮尔逊相关系数较高。学员的自评分数与评估人员的评分相关性不佳。SIC-Ex是第一个为纳入SIG指南框架以评估住院医师能力提供证据的评估工具。在评估重病诊疗谈话技巧方面，SIC-Ex在概念上与CCG相关，但比CCG更具针对性。
