Von Gunten C F, Von Roenn J H, Gradishar W, Weitzman S
Hematology/Oncology, Northwestern University Medical School, Chicago, IL 60611, USA.
J Cancer Educ. 1995 Winter;10(4):200-2. doi: 10.1080/08858199509528373.
A clinical hospice/palliative medicine rotation for physicians enrolled in a three-year hematology/oncology fellowship was established in academic year 1993-1994 as a way to accomplish important training goals in pain management and the palliative care of patients with terminal illness. This study was conducted to obtain initial information about its effectiveness. Ten fellows, one at a time, evaluated new hospice/palliative medicine consultations, supervised the care of patients on an inpatient hospice/palliative care unit, and visited patients at home. For the first 13 months, seven fellows were assigned to this rotation for one month each, and three fellows were assigned to spend two separate months each. A self-report evaluation of the experience was administered at the end of each service month. In five of these 13 evaluations, the fellows reported their skills in managing pain and symptoms to be much improved, and in eight they indicated their skills were improved; none stated that there had been no change. Comfort and skill with discussing death, dying, and advanced directives with patients and families were reported by the fellows to be much improved in nine evaluations, improved in three, and unchanged in one. In nine evaluations, the fellows reported their understanding of hospice/palliative care as a program and approach to patient care was much improved; in two, improved; and in two, unchanged. All of the fellows would recommend this rotation to other fellows. A clinical rotation in palliative medicine and hospice care is a useful addition to the curriculum of fellows training in hematology-oncology.
1993 - 1994学年，为参加三年血液学/肿瘤学 fellowship 的医生设立了临床临终关怀/姑息医学轮转项目，作为实现疼痛管理和晚期疾病患者姑息治疗重要培训目标的一种方式。本研究旨在获取有关其有效性的初步信息。十名研究员一次一名，评估新的临终关怀/姑息医学会诊，监督住院临终关怀/姑息治疗病房患者的护理，并上门探访患者。在最初的13个月里，七名研究员每人被分配到该轮转项目一个月，三名研究员每人被分配到两个月。在每个服务月结束时进行了对该经历的自我报告评估。在这13次评估中的5次，研究员报告他们管理疼痛和症状的技能有了很大提高，8次表示他们的技能有所提高；没有人表示没有变化。在9次评估中，研究员报告他们在与患者及家属讨论死亡、临终和预先指示方面的舒适度和技能有了很大提高，3次表示有所提高，1次表示没有变化。在9次评估中，研究员报告他们对临终关怀/姑息治疗作为一种患者护理项目和方法的理解有了很大提高；2次表示有所提高；2次表示没有变化。所有研究员都向其他研究员推荐这个轮转项目。姑息医学和临终关怀护理的临床轮转是血液学 - 肿瘤学研究员培训课程中一个有用的补充。
