Fielding the quality of communication questionnaire to persons with cognitive impairment and their family in primary care: A pilot study.
Fielding the quality of communication questionnaire to persons with cognitive impairment and their family in primary care: A pilot study.
复制标题
向初级保健中的认知障碍患者及其家人进行沟通质量调查问卷：一项试点研究。
DOI：
10.1111/jgs.18034
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发表时间：
2023
影响因子：
6.3
通讯作者：
Wolff,JenniferL
中科院分区：
文献类型：
--
作者：
Reiff,JenniS;Cagle,John;Zhang,Talan;Roth,DavidL;Wolff,JenniferL
背景沟通质量（QOC）问卷已被广泛用于评估患者与临床医生之间关于临终关怀（EOL）沟通的基本方面。然而，这个工具从来没有被派往与初级保健患者谁有认知障碍和他们的照顾者，人口与独特的沟通needs.DesignWe报告的基线数据从一个已完成的试点研究和正在进行的疗效试验的提前护理计划，涉及二人组的初级保健患者年龄80岁及以上的认知障碍和他们的家庭护理合作伙伴。两个QOC分量表评估了一般沟通和EOL护理沟通的评分，从0（“最差”）到10（“最佳”）。由于EOL分量表试点的挑战，我们整合了跳跃逻辑，以提高认知可及性和测量精度。参与者首先被问到是否发生了EOL通信（是/否）;那些回答肯定的人随后被要求对通信进行评级。我们报告了正在进行的试验中使用EOL子量表调整的经验（NCT 04593472）。结果在我们的试点中使用原始仪器（13对），平均患者和家庭一般沟通评级相似（分别为9.65和9.60），但EOL评级出现分歧（分别为4.23和5.88），“不知道”包括5%的患者和32%的家庭反应。访谈者报告称，当被要求对尚未发生的EOL沟通行为进行评级时，患者和家属参与者表示困惑。在我们的有效性试验（43对）中使用改编的工具，最常报告的EOL沟通行为为未发生（所有项目中76%的患者和73%的家庭反应）。平均患者和家庭EOL子量表评级相似（2.23和2.26）和响应的“不知道”是最小的（<1%）。ConclusionThe original QOC EOL子量表涉及评级对话很少发生在初级保健，但重要的是老年人认知障碍。子尺度适应可以减少混淆和响应不确定性，并提高测量精度。
BackgroundThe quality of communication (QOC) questionnaire has been widely used to assess foundational aspects of patient‐clinician communication about end‐of‐life (EOL) care. However, this instrument has never before been fielded with primary care patients who have cognitive impairment and their caregivers, a population with unique communication needs.DesignWe report on baseline data from a completed pilot study and ongoing efficacy trial of advance care planning involving dyads of primary care patients ages 80 and older with cognitive impairment and their family care partners. Two QOC subscales assessed ratings of general communication and EOL care communication from 0 (“worst”) to 10 (“best”). Due to challenges piloting the EOL subscale, we integrated skip logic to improve cognitive accessibility and measurement precision. Participants were first asked whether EOL communication occurred (yes/no); those responding affirmatively were subsequently asked to rate communication. We report experiences with EOL subscale adaptations from our ongoing trial (NCT04593472).ResultsUsing the original instrument in our pilot (13 dyads), mean patient and family general communication ratings were similar (9.65 and 9.60, respectively), but EOL ratings diverged (4.23 and 5.88, respectively), and “Don't Know” comprised 5% of patient and 32% of family responses. Interviewers reported patient and family participants expressed confusion when asked to rate EOL communication behaviors that had not occurred. Using the adapted instrument in our efficacy trial (43 dyads), EOL communication behaviors were most often reported as not having occurred (76% of patient and 73% of family responses across all items). Mean patient and family EOL subscale ratings were similar (2.23 and 2.26) and responses of “Don't Know” were minimal (<1%).ConclusionThe original QOC EOL subscale involves rating conversations that rarely occur in primary care but are important for older adults with cognitive impairment. Subscale adaptations may reduce confusion and response uncertainty and improve measurement accuracy.