Department of Medical Oncology, BC Cancer Agency Abbostford Centre, Abbotsford, British Columbia, Canada
Department of Critical Care Medicine and Division of Palliative Medicine; Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
BMJ Open. 2024 Jan 29;14(1):e078385. doi: 10.1136/bmjopen-2023-078385.
The Serious Illness Conversation Guide (SICG) has emerged as a framework for conversations with patients with a serious illness diagnosis. This study reports on narratives generated from open-ended questions of a novel assessment tool, the Serious Illness Conversation-Evaluation Exercise (SIC-Ex), to assess resident-led conversations with patients in oncology outpatient clinics.
Qualitative study using template analysis.
Three academic cancer centres in Canada.
7 resident physicians (trainees), 7 patients from outpatient cancer clinics, 10 preceptors (raters) consisting of medical oncologists, palliative care physicians and radiation oncologists.
Each trainee conducted an SIC with a patient, which was videotaped. The raters watched the videos and evaluated each trainee using the novel SIC-Ex and the reference Calgary-Cambridge Guide (CCG) initially and again 3 months later. Two independent coders used template analysis to code the raters' narrative comments and identify themes/subthemes.
How narrative comments aligned with elements of the CCG and SICG.
Template analysis yielded four themes: adhering to SICG, engaging patients and family members, conversation management and being mindful of demeanour. Narrative comments identified numerous verbal and non-verbal elements essential to SICG. Some comments addressing general skills in engaging patients/families and managing the conversation (eg, setting agenda, introduction, planning, exploring, non-verbal communication) related to both the CCG and SICG, whereas other comments such as identifying substitute decision maker(s), affirming commitment and introducing Advance Care Planning were specific to the SICG.
Narrative comments generated by SIC-Ex provided detailed and nuanced insights into trainees' competence in SIC, beyond the numerical ratings of SIC-Ex and the general communication skills outlined in the CCG, and may contribute to a more fulsome assessment of SIC skills.
严重疾病对话指南（SICG）已成为与患有严重疾病患者进行对话的框架。本研究报告了一种新型评估工具——严重疾病对话评估练习（SIC-Ex）的开放式问题所产生的叙述，以评估住院医师在肿瘤门诊诊所与患者进行的对话。
使用模板分析的定性研究。
加拿大的三个学术癌症中心。
7 名住院医师（受训者）、7 名来自门诊癌症诊所的患者、10 名导师（评估者），包括肿瘤内科医生、姑息治疗医生和放射肿瘤医生。
每位受训者与一名患者进行 SIC，该对话被录像。评估者观看视频，并使用新型 SIC-Ex 和参考卡尔加里-剑桥指南（CCG）最初以及 3 个月后再次对每位受训者进行评估。两名独立的编码员使用模板分析对评估者的叙述性评论进行编码，并确定主题/子主题。
叙述性评论与 CCG 和 SICG 元素的一致性。
模板分析产生了四个主题：遵循 SICG、吸引患者及其家属、对话管理和注意举止。叙述性评论确定了许多与 SICG 相关的口头和非口头元素。一些评论涉及与 CCG 和 SICG 都相关的吸引患者/家属和管理对话的一般技能（例如，设定议程、介绍、计划、探索、非语言沟通），而其他评论，例如识别替代决策者、肯定承诺和介绍预先护理计划，是 SICG 特有的。
SIC-Ex 的叙述性评论提供了关于受训者在 SIC 方面的能力的详细和细致入微的见解，超出了 SIC-Ex 的数字评分以及 CCG 中概述的一般沟通技能，并且可能有助于更全面地评估 SIC 技能。
