由专业护士为健康的BRCA1/2基因突变携带者提供的以护士为主导的决策指导——护士课程的改编与试点测试：一项定性研究
Nurse-led decision coaching by specialized nurses for healthy BRCA1/2 gene mutation carriers - adaptation and pilot testing of a curriculum for nurses: a qualitative study.
作者信息
Berger-Höger Birte, Vitinius Frank, Fischer Hannah, Beifus Karolina, Köberlein-Neu Juliane, Isselhard Anna, Töpper Maren, Wiedemann Regina, Rhiem Kerstin, Schmutzler Rita, Stock Stephanie, Steckelberg Anke
机构信息
Institute for Health and Nursing Science, Faculty of Medicine Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
出版信息
BMC Nurs. 2022 Feb 10;21(1):42. doi: 10.1186/s12912-022-00810-8.
BACKGROUND
Women with BRCA1/2 mutations are at high risk to develop breast and ovarian cancer. To support these women to participate in shared decision-making, structured nurse-led decision coaching combined with an evidence-based decision aid may be employed. In preparation of the interprofessional randomized controlled trial to evaluate a decision coaching program to support preventive decisions of healthy female BRCA 1/2 gene mutation carriers (EDCP-BRCA), we adapted and piloted an existing training program for specialized nurses and included elements from an existing physician communication training.
METHODS
The training was adapted according to the six-step-approach for medical curriculum development. The educational design is based on experience- and problem-based learning. Subsequently, we conducted a qualitative pilot study. Nurses were recruited from six German centers for familial breast and ovarian cancer. The acceptability and feasibility were assessed by structured class observations, field notes and participants' feedback. Data were analyzed using qualitative content analysis. The training was revised according to the results. Due to the COVID-19 pandemic, the patient intervention was adapted as a virtual coaching and a brief additional training for nurses was added.
RESULTS
The training consists of two modules (2 + 1 day) that teach competences in evidence-based medicine and patient information, (risk) communication and decision coaching. One pilot test was conducted with six nurses of which three were specialized and experienced in patient counselling. A final set of eight main categories was derived from the data: framework conditions; interaction; schedule, transparency of goals, content, methods, materials and practical relevance and feasibility. Overall, the training was feasible and comprehensible. Decision coaching materials were awkward to handle and decision coaching role plays were set too short. Therefore, materials will be sent out in advance and the training was extended.
CONCLUSIONS
Specialized nurses are rarely available and nurse-led counselling is not routinely implemented in the centers of familial breast and ovarian cancer. However, training of less qualified nurses seems feasible. Decision coaching in a virtual format seems to be a promising approach. Further research is needed to evaluate its feasibility, acceptability and effectiveness.
TRIAL REGISTRATION
The main trial is registered under DRKS-ID: DRKS00015527 .
背景
携带BRCA1/2基因突变的女性患乳腺癌和卵巢癌的风险很高。为支持这些女性参与共同决策，可采用由护士主导的结构化决策指导，并结合基于证据的决策辅助工具。在准备一项跨专业随机对照试验以评估一项决策指导计划，该计划旨在支持健康的BRCA 1/2基因突变女性携带者的预防性决策（EDCP-BRCA）时，我们对现有的专科护士培训计划进行了调整和试点，并纳入了现有医生沟通培训的内容。
方法
培训根据医学课程开发的六步法进行调整。教育设计基于经验和问题导向学习。随后，我们进行了一项定性试点研究。从六个德国家族性乳腺癌和卵巢癌中心招募护士。通过结构化课堂观察、现场记录和参与者反馈来评估可接受性和可行性。使用定性内容分析法对数据进行分析。根据结果对培训进行修订。由于COVID-19大流行，患者干预调整为虚拟指导，并为护士增加了简短的额外培训。
结果
培训包括两个模块（2 + 1天），教授循证医学、患者信息、（风险）沟通和决策指导方面的能力。对六名护士进行了一次试点测试，其中三名护士在患者咨询方面经验丰富。从数据中得出了最终的八个主要类别：框架条件；互动；时间表、目标透明度、内容、方法、材料以及实际相关性和可行性。总体而言，培训是可行且易于理解的。决策指导材料操作不便，决策指导角色扮演设置时间过短。因此，将提前发送材料，并延长培训时间。
结论
专科护士很少，家族性乳腺癌和卵巢癌中心也未常规开展由护士主导的咨询服务。然而，对资质较低的护士进行培训似乎是可行的。虚拟形式的决策指导似乎是一种很有前景的方法。需要进一步研究以评估其可行性、可接受性和有效性。
试验注册
主要试验已在DRKS-ID：DRKS00015527下注册。
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