Doherty Megan, Gujral Preet, Frenette Maryse, Lusney Nadine, van Breemen Camara
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Palliat Support Care. 2024 Oct;22(5):1048-1055. doi: 10.1017/S1478951523000500.
To explore experiences of pediatric clinicians participating in a serious illness communication program (SICP) for advance care planning (ACP), examining how the SICP supports clinicians to improve their communication and the challenges of implementing new communication tools into clinical practice.
A qualitative description study using individual interviews with a diverse group of pediatric clinicians who participated in 2.5-hour SICP training workshops at pediatric tertiary hospitals. Discussions were transcribed, coded, and arranged into overarching themes. Thematic analysis was conducted using interpretive description methodology.
Fourteen clinicians from 2 Canadian pediatric tertiary hospital settings were interviewed, including nurses (36%), physicians (36%), and social workers (29%), from the fields of neonatology (36%), palliative care (29%), oncology (21%), and other pediatric specialties (14%). Key themes included specific benefits of SICP, with subthemes of connecting with families, increased confidence in ACP discussions, providing tools to improve communication, and enhanced self-awareness and self-reflection. A second theme of perceived challenges emerged, which included subthemes of not having the conversation guide readily accessible, divergent team communication practices, and particular features of the clinical environment which limited the possibility of engaging in ACP discussions with parents.
A structured program to enhance serious illness communication supports clinicians to develop skills and tools to increase their confidence and comfort in conducting conversations about end-of-life issues. Addressing challenges of adopting the newly learned communication practices, by providing access to digital SICP tools and conducting SICP training for clinical teams may further support clinicians to engage in ACP.
探讨参与重病沟通计划（SICP）以进行预先护理计划（ACP）的儿科临床医生的经历，研究SICP如何支持临床医生改善沟通以及在临床实践中实施新沟通工具所面临的挑战。
采用定性描述性研究，对参加儿科三级医院2.5小时SICP培训工作坊的不同儿科临床医生群体进行个人访谈。讨论内容被转录、编码并归纳为总体主题。使用解释性描述方法进行主题分析。
对来自2家加拿大儿科三级医院的14名临床医生进行了访谈，包括护士（36%）、医生（36%）和社会工作者（29%），涉及新生儿科（36%）、姑息治疗（29%）、肿瘤学（21%）和其他儿科专科（14%）领域。关键主题包括SICP的具体益处，其亚主题有与家庭建立联系、在ACP讨论中增强信心、提供改善沟通的工具以及增强自我意识和自我反思。出现的第二个主题是感知到的挑战，其亚主题包括无法随时获取对话指南、团队沟通方式存在差异以及临床环境的特定特征限制了与家长进行ACP讨论的可能性。
一个强化重病沟通的结构化计划支持临床医生发展技能和工具，以增强他们在进行临终问题对话时的信心和舒适度。通过提供数字SICP工具并为临床团队开展SICP培训来应对采用新学沟通实践所面临的挑战，可能会进一步支持临床医生参与ACP。
