Julius Center for Health Sciences and Primary Care, Center of Expertise in Palliative Care Utrecht, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
BMC Palliat Care. 2024 Aug 3;23(1):196. doi: 10.1186/s12904-024-01515-2.
Advance Care Planning (ACP) enables patients and relatives to define and share values, goals and preferences for future medical treatment and care. The IMplementing Pediatric Advance Care Planning Toolkit (IMPACT), developed in the Netherlands, is a method for conducting ACP in pediatric palliative care. Healthcare professionals who were trained to use IMPACT, indicated their need for ongoing support to practice ACP communication skills optimally over time. Therefore, we developed a team-based learning program aimed at teaching participants how to transfer knowledge on ACP, continue practicing ACP communication skills and reflect on ACP conversations within their own team context. The aim of this study was to evaluate the program's transfer of knowledge as well as the professionals' experience and team reflection on ACP.
A one-day IMPACT train-the-trainer course was developed and a selection of healthcare professionals (facilitators) from pediatric palliative care teams (PPCTs) from all seven Dutch university hospitals and the specialized Center for Pediatric Oncology were invited to participate. Hereafter, facilitators were asked to transfer their course-acquired knowledge to their team members (learners) by organizing two coaching-on-the-job sessions. A mixed-methods design, combining questionnaires and field notes, was used to evaluate the level of knowledge transfer and team reflection achieved.
Eighteen healthcare professionals in the role of facilitator participated in the train-the-trainer course. In seven PPCTs one (n = 3) or two (n = 4) coaching-on-the-job session(s) took place, attended by 29 and 17 learners, respectively. In the questionnaires, 11 facilitators indicated that they had to some extent transferred acquired knowledge to their team members as intended. Sixteen out of 21 learners who participated in at least one coaching-on-the-job session, reported (somewhat) increased self-confidence for conducting ACP conversations. The reported main strength of the program was practicing with/learning from colleagues whereas dealing with workload and variation in existing ACP skills within PPCTs need more attention.
The newly developed team-based learning program resulted in intended transfer of knowledge and methodical reflection on ACP in coaching-on-the-job sessions in most participating PPCTs. Planning coaching-on-the-job sessions regarding ACP in pediatric palliative care with multiple healthcare professionals is challenging and needs more emphasis in the training.
预先医疗照护计划（ACP）使患者和家属能够定义和分享对未来医疗和护理的价值观、目标和偏好。荷兰开发的实施儿科预先医疗照护计划工具包（IMPACT）是一种在儿科姑息治疗中进行 ACP 的方法。接受过使用 IMPACT 培训的医疗保健专业人员表示，他们需要持续的支持，以便随着时间的推移优化 ACP 沟通技巧的实践。因此，我们开发了一个基于团队的学习计划，旨在教授参与者如何传授 ACP 知识，继续练习 ACP 沟通技巧，并在自己的团队环境中反思 ACP 对话。本研究的目的是评估该计划在知识转移方面的效果，以及专业人员对 ACP 的经验和团队反思。
开发了为期一天的 IMPACT 培训师课程，并邀请来自荷兰七所大学医院和专门的儿科肿瘤中心的儿科姑息治疗团队（PPCT）的医疗保健专业人员（促进者）参加。此后，促进者被要求通过组织两次在职辅导课程，将他们在课程中获得的知识传授给团队成员（学习者）。采用结合问卷调查和现场记录的混合方法设计来评估所实现的知识转移和团队反思水平。
18 名医疗保健专业人员担任促进者参加了培训师课程。在七个 PPCT 中，有一个（n=3）或两个（n=4）在职辅导课程，分别有 29 名和 17 名学习者参加。在问卷调查中，11 名促进者表示，他们已经在一定程度上将所获得的知识传授给了团队成员。17 名至少参加过一次在职辅导课程的学习者中，有 16 人报告说（在某种程度上）在进行 ACP 对话时增加了自信心。该计划的主要优势是与同事一起实践/学习，而在 PPCT 中需要更多关注工作量和现有的 ACP 技能差异。
新开发的基于团队的学习计划导致了大多数参与的 PPCT 中在职辅导课程中预期的知识转移和 ACP 的方法性反思。计划在儿科姑息治疗中与多名医疗保健专业人员一起进行 ACP 的在职辅导课程具有挑战性，需要在培训中更加重视。
