Prachanukool Thidathit, Yuksen Chaiyaporn, Jintanavasan Sirada, Jenpanitpong Chetsadakon, Watcharakitpaisan Sorawich, Kaninworapan Parama, Maijan Konwachira
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Adv Med Educ Pract. 2021 Sep 29;12:1111-1118. doi: 10.2147/AMEP.S323557. eCollection 2021.
Palliative care is an approach to improve quality of life in patients with life-limiting diseases. The sudden nature of such conditions involves emergency providers as the first responders, who have roles in delivering appropriate care to meet patients' needs. In this study, we evaluated whether previous experience in palliative care among paramedic students could affect their decision-making skills in prehospital work.
This questionnaire-based prospective cross-sectional study was conducted from October 2019 to November 2020. We compared two groups of paramedic students in a tertiary hospital in Bangkok, Thailand. The class of 2019 did not attend palliative care courses and the class of 2020 completed a 2-week course regarding in-hospital palliative care services. Questionnaires including rating scales and checklists and involving cases with and without malignancy were completed via a web-based data collection form. The reliability of the questionnaire was tested. Decision-making skills were categorized into seven domains comprising life-sustaining treatment, withholding or withdrawing life-sustaining treatment, advance care planning, self-autonomy, decision-making capacity and surrogate decision-makers, prehospital dyspnea management, and communication skills.
Among 57 paramedics, 52 (91%) completed the questionnaire. There was no significant difference in decision-making between the two groups in all seven domains (p>0.050). Overall, participants more often recognized patients who were eligible for palliative care and made more decisions to withhold or withdraw life-sustaining treatment when patients had advanced malignancy than in cases of non-malignancy (100% and 84.6% respectively, p=0.006).
Our findings showed that the decision-making process for patients regarding prehospital palliative care was not significantly different between two groups of emergency personnel with and without in-hospital palliative care experience.
姑息治疗是一种提高患有危及生命疾病患者生活质量的方法。此类疾病的突发性使急救人员成为首要响应者，他们在提供适当护理以满足患者需求方面发挥着作用。在本研究中，我们评估了护理专业学生先前的姑息治疗经验是否会影响他们在院前工作中的决策技能。
这项基于问卷的前瞻性横断面研究于2019年10月至2020年11月进行。我们比较了泰国曼谷一家三级医院的两组护理专业学生。2019级学生未参加姑息治疗课程，2020级学生完成了为期两周的院内姑息治疗服务课程。通过基于网络的数据收集表完成了包括评分量表和检查表的问卷，问卷涉及有和没有恶性肿瘤的病例。对问卷的信度进行了测试。决策技能分为七个领域，包括维持生命治疗、停止或撤销维持生命治疗、预先护理计划、自我自主权、决策能力和替代决策者、院前呼吸困难管理以及沟通技能。
在57名护理人员中，52名（91%）完成了问卷。两组在所有七个领域的决策方面均无显著差异（p>0.050）。总体而言，与非恶性肿瘤病例相比，当患者患有晚期恶性肿瘤时，参与者更常识别出符合姑息治疗条件的患者，并且做出更多停止或撤销维持生命治疗的决定（分别为100%和84.6%，p=0.006）。
我们的研究结果表明，对于院前姑息治疗患者的决策过程，在有和没有院内姑息治疗经验的两组急救人员之间没有显著差异。
