Lundeby Tonje, Finset Arnstein, Kaasa Stein, Wester Torunn Elin, Hjermstad Marianne Jensen, Dajani Olav, Wist Erik, Aass Nina
European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
J Commun Healthc. 2023 Mar;16(1):46-57. doi: 10.1080/17538068.2022.2039468. Epub 2022 Feb 20.
Early integration of oncology and patient-centered palliative care is the recommended clinical practice model for patients with advanced cancer. General and specific communication skills are necessary to achieve integrated patient-centered care, but require organized training to be adequately mastered. Challenges and barriers on several levels, i.e. organizational, professional and individual may, however, hamper implementation. The development, implementation, and evaluation of such an educational program focusing on communication skills contain many steps, considerations and lessons learned, which are described in this article. A multi-professional faculty developed, implemented, and evaluated an educational program through a 5-step approach. The program was part of a Norwegian cluster-randomized controlled trial aiming to test the effect of early integration of oncology and palliative care for patients with advanced cancer. The result is the PALLiON educational program; a multi-faceted, evidence-based, and learner-centered program with a specific focus on physicians' communication skills. Four modules were developed: lectures, discussion groups, skills training, and coaching. These were implemented at the six intervention hospitals using different teaching strategies. Evaluation in a subgroup of participants showed a positive appraisal of the group discussions and skills training.We present our experiences and reflections regarding implementation and lessons learned, which should be considered in future developments and implementations; (1) Include experienced faculty with various backgrounds, (2) Be both evidence-based and learner-centered, (3) Choose teaching strategies wisely, (4) Expect resistance and skepticism, (5) Team up with management and gatekeepers, (6) Expect time to fly, and (7) Plan thorough assessment of the evaluation and effect. ClinicalTrials.gov identifier: NCT03088202.
肿瘤学与以患者为中心的姑息治疗的早期整合是晚期癌症患者推荐的临床实践模式。实现以患者为中心的综合护理需要一般和特定的沟通技巧，但需要有组织的培训才能充分掌握。然而，在组织、专业和个人等多个层面上的挑战和障碍可能会阻碍实施。本文描述了这样一个侧重于沟通技巧的教育项目的开发、实施和评估所包含的许多步骤、考虑因素和经验教训。一个多专业教师团队通过五步方法开发、实施并评估了一个教育项目。该项目是挪威一项整群随机对照试验的一部分，旨在测试肿瘤学与姑息治疗早期整合对晚期癌症患者的效果。结果就是PALLiON教育项目；这是一个多方面、基于证据且以学习者为中心的项目，特别关注医生的沟通技巧。开发了四个模块：讲座、讨论小组、技能培训和辅导。这些模块在六家干预医院采用不同的教学策略实施。对一部分参与者的评估显示对小组讨论和技能培训给予了积极评价。我们介绍了关于实施的经验和思考以及经验教训，这些在未来的开发和实施中应予以考虑；（1）纳入具有不同背景的经验丰富的教师，（2）既基于证据又以学习者为中心，（3）明智地选择教学策略，（4）预料到会有抵触和怀疑，（5）与管理层和把关人合作，（6）预料到时间过得很快，（7）计划对评估和效果进行全面评估。ClinicalTrials.gov标识符：NCT03088202。
