Collinge William, Kozak Leila, Mist Scott, Soltysik Robert
Collinge and Associates, Inc., Eugene, OR, USA.
Integrative Palliative Care Institute, Redmond, WA, USA.
Glob Adv Integr Med Health. 2025 Jan 7;14:27536130241309851. doi: 10.1177/27536130241309851. eCollection 2025 Jan-Dec.
Integrative therapies are increasingly in demand for both symptom management and quality of life in palliative care (PC) populations. Multidisciplinary PC professionals need continuing education/continuing medical education (CE/CME) to keep current on the evidence-informed use of integrative therapies in PC planning.
(1) Elicit input from multidisciplinary PC providers on needs for CE/CME content on integrative care, and indicators of implementation for use in impact assessment. (2) Produce an online CE/CME program responsive to provider input. (3) Assess program impact on PC providers in a randomized controlled trial.
Focus groups with 47 multidisciplinary PC personnel assessed needs for CE/CME content and identified practice-related behaviors indicating implementation of integrative care. Qualitative analysis then informed development a 9-hour CE/CME program, and identified candidate items for an outcome measure (Integrative Practice Assessment) to assess impact. Validation testing followed with 63 new subjects. A randomized, waitlist-controlled trial then assessed program impact on (1) confidence understanding evidence-informed use of integrative therapies in PC, and (2) implementation of practice behaviors that promote integrative care.
213 subjects were randomized and 170 provided follow-up data on program impact. Subjects' confidence (10-point scale) understanding safety considerations increased from 5.4 to 8.7; recommending modalities, from 4.2 to 8.3; and explaining modalities, from 4.8 to 8.5. Direct actions promoting integrative care in the last 10 patient encounters increased (12.2 to 17.9). Indirect actions taken in the work setting increased in the past month to advocate integrative therapies (from 5.7 to 9.1), and to promote organizational change (from 10.9 to 18.2). (All outcomes < .001).
This provider-driven CE/CME program led to significant positive changes in practitioners' self-efficacy and implementation of integrative care practices in PC settings. The results indicate that CE/CME can have measurable impacts that benefit providers and may potentially impact patients, families and the culture of care.
在姑息治疗（PC）人群中，综合疗法对于症状管理和生活质量的需求日益增加。多学科的PC专业人员需要持续教育/继续医学教育（CE/CME），以便在PC规划中及时了解综合疗法的循证应用。
（1）从多学科PC提供者那里获取关于综合护理CE/CME内容需求以及用于影响评估的实施指标的意见。（2）根据提供者的意见制作一个在线CE/CME项目。（3）在一项随机对照试验中评估该项目对PC提供者的影响。
与47名多学科PC人员进行焦点小组讨论，评估CE/CME内容需求，并确定表明综合护理实施情况的与实践相关的行为。定性分析随后为一个9小时的CE/CME项目的开发提供了信息，并确定了用于评估影响的结果测量（综合实践评估）的候选项目。随后对63名新受试者进行了验证测试。一项随机、等待列表对照试验随后评估了该项目对以下方面的影响：（1）对在PC中循证使用综合疗法的信心理解；（2）促进综合护理的实践行为的实施。
213名受试者被随机分组，170名提供了关于项目影响的随访数据。受试者对安全考虑的理解信心（10分制）从5.4提高到8.7；推荐治疗方式的信心从4.2提高到8.3；解释治疗方式的信心从4.8提高到8.5。在最近10次患者诊疗中促进综合护理的直接行动有所增加（从12.2增加到17.9）。在过去一个月里，在工作环境中采取的倡导综合疗法（从5.7增加到9.1）和促进组织变革（从10.9增加到18.2）的间接行动有所增加。（所有结果P <.001）。
这个由提供者驱动的CE/CME项目导致了PC环境中从业者自我效能和综合护理实践实施方面的显著积极变化。结果表明，CE/CME可以产生可衡量的影响，使提供者受益，并可能潜在地影响患者、家庭和护理文化。
