Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist, Taoyuan, Taiwan.
BMC Med Educ. 2022 May 23;22(1):397. doi: 10.1186/s12909-022-03458-9.
Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP.
For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations.
IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen's d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%).
ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.
由于终末期肾病（ESRD）患者的治疗决策后果是长期且重大的，因此，肾病学领域的医疗保健人员（HCP）需要具备良好的沟通技巧。然而，HCP 的工作安排繁忙，参加面对面课程较为困难。因此，在线课程在医学教育中逐渐兴起。本研究旨在检验在线 ESRD 沟通技巧培训（CST）对 HCP 讲真话信心和共享决策（SDM）能力的有效性。
在这项单中心、单盲研究中，91 名参与者（肾病医生和肾病护士）被随机分配到两组，干预组（IG）（n=45）和对照组（CG）（n=46），IG 组参加 ESRD CST，CG 组接受常规在职培训。在干预前（T0）、干预后 2 周（T1）和 4 周（T2）时测量讲真话的信心和 SDM 能力。使用广义估计方程分析研究期间的组间差异。
IG 组参与者在 T1 时的讲真话信心明显高于 CG 组参与者（t=2.833，P=.006，Cohen's d=0.59），而两组参与者在 T0 和 T2 时的信心水平没有显著差异。关于 SDM 能力，在三个时间点均没有显著的组间差异。然而，IG 组参与者的满意度很高（n=43，95%），并愿意向他人推荐 ESRD CST（n=41，91.1%）。
ESRD CST 增强了短期的讲真话信心，但尚不清楚这是由于 CST 内容还是在线授课所致。然而，在大流行期间，面对面培训不适合时，在线 CST 是不可或缺的工具。未来的 CST 干预研究应精心设计互动模块，并控制教学方法。
