Department of Medicine, Division of Oncology, Stanford School of Medicine, Stanford, CA, USA.
Department of Digestive Diseases and Transplantation, Einstein Healthcare Network, Philadelphia, PA, USA.
Hepatol Commun. 2022 Apr;6(4):920-930. doi: 10.1002/hep4.1849. Epub 2021 Oct 31.
Palliative care (PC) benefits patients with serious illness including end-stage liver disease (ESLD). As part of a cluster randomized trial, hepatologists were trained to deliver primary palliative care to patients with ESLD using an online course, Palliative Care Always: Hepatology (PCA:Hep). Here we present a multimethod formative evaluation (feasibility, knowledge acquisition, self-efficacy, and practice patterns) of PCA:Hep. Feasibility was measured by completion of coursework and achieving a course grade of >80%. Knowledge acquisition was measured through assessments before and throughout the course. Pre/post-course surveys were conducted to determine self-efficacy and practice patterns. The hepatologists (n = 39) enrolled in a 12-week online course and spent 1-3 hours on the course weekly. The course was determined to be feasible as 97% successfully completed the course and 100% passed. The course was acceptable to participants; 91.7 % reported a positive course experience and satisfaction with knowledge gained (91.6%). The pre/post knowledge assessment showed an improvement of 6.0% (pre 85.9% to post 91.9%, 95% CI [2.8, 9.2], P = 0.001). Self-efficacy increased significantly (P < 0.001) in psychological symptom management, hospice, and psychosocial support. A year after training, over 80% of the hepatologists reported integrating a variety of PC skills into routine patient care. Conclusion: PCA:Hep is feasible, acceptable, and improves learner knowledge and confidence in palliative care skills. This is a viable method to teach primary PC skills to specialists caring for patients with ESLD.
姑息治疗（PC）可使包括终末期肝病（ESLD）在内的严重疾病患者受益。作为一项整群随机试验的一部分，通过在线课程“始终提供姑息治疗：肝脏病学（PCA：Hep）”，对肝脏病学家进行培训，以向 ESLD 患者提供初级姑息治疗。在这里，我们介绍了 PCA：Hep 的多方法形成性评估（可行性、知识获取、自我效能和实践模式）。可行性通过完成课程作业和获得 >80%的课程成绩来衡量。知识获取通过课程前后的评估来衡量。通过课前/课后调查来确定自我效能和实践模式。39 名肝脏病学家参加了为期 12 周的在线课程，每周在课程上花费 1-3 小时。97%的人成功完成了课程，100%的人通过了课程，这表明该课程是可行的。该课程得到了参与者的认可；91.7%的人报告说课程体验良好，对所学知识感到满意（91.6%）。课前/课后知识评估显示，知识提高了 6.0%（课前 85.9%，课后 91.9%，95%置信区间[2.8，9.2]，P=0.001）。自我效能在心理症状管理、临终关怀和心理社会支持方面显著提高（P<0.001）。培训一年后，超过 80%的肝脏病学家报告说，他们将各种姑息治疗技能整合到常规患者护理中。结论：PCA：Hep 是可行的、可接受的，可提高学习者对姑息治疗技能的知识和信心。这是向治疗 ESLD 患者的专家教授初级姑息治疗技能的一种可行方法。
