Pennarola Adam, Yoshioka Tammy, Shah Dhruvi, Larson Sharon
23217Thomas Jefferson University Hospital, Philadelphia, PA, USA.
20284Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research (LIMR), Wynnewood, PA, USA.
Am J Hosp Palliat Care. 2023 Apr;40(4):387-395. doi: 10.1177/10499091221102141. Epub 2022 May 18.
As demand for palliative care (PC) services rise, there are insufficient numbers of PC specialists to provide PC for the US population. "Primary palliative care" refers to PC services that are administered by non-specialist PC providers. Educating trainees in graduate medical education (GME) programs is 1 strategy for expanding primary palliative care, though questions remain regarding the impact of PC education for GME trainees and where additional education is needed. This study is a multicenter, cross-sectional, web-based survey study of GME trainees assessing the needs for and impacts of primary palliative care education. The survey assessed the implementation of and participants' confidence with fundamental PC skills. The survey also asked about prior exposure to PC education and for participants' beliefs regarding areas that would be particularly helpful for future education. 170 residents and fellows from diverse training backgrounds participated in the survey out of 851 potential participants (response rate 19.98%). Exposure to PC education was associated with higher confidence and increased frequency of implementation of fundamental PC skills. Of the forms of education that were assessed, clinical/experiential education was associated most often with higher confidence and higher frequency of use of PC skills. Discussing goals of care, pain management for seriously ill patients, and communicating difficult information were those skills most frequently identified as important for additional training. This study demonstrates that by improving existing PC education or increasing access to PC education for GME trainees, it may be possible to improve primary palliative care.
随着姑息治疗（PC）服务需求的增加，美国缺乏足够数量的PC专科医生为民众提供姑息治疗。“初级姑息治疗”是指由非专科PC提供者提供的PC服务。在毕业后医学教育（GME）项目中培训学员是扩大初级姑息治疗的一种策略，不过关于PC教育对GME学员的影响以及何处需要额外教育仍存在疑问。本研究是一项针对GME学员的多中心、横断面、基于网络的调查研究，评估初级姑息治疗教育的需求和影响。该调查评估了基本PC技能的实施情况以及参与者的信心。调查还询问了参与者之前接受PC教育的情况，以及他们对未来教育特别有帮助的领域的看法。在851名潜在参与者中，170名来自不同培训背景的住院医师和研究员参与了调查（回复率为19.98%）。接受PC教育与更高的信心以及基本PC技能实施频率的增加相关。在评估的教育形式中，临床/体验式教育最常与更高的信心和PC技能的更高使用频率相关。讨论护理目标、重症患者的疼痛管理以及传达困难信息是那些最常被认为对额外培训很重要的技能。这项研究表明，通过改进现有的PC教育或增加GME学员接受PC教育的机会，有可能改善初级姑息治疗。
