Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure.
Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure.
复制标题
评估一种新型教育干预措施，以改善晚期心力衰竭患者植入式心脏复律除颤器管理的对话。
DOI：
10.1089/jpm.2020.0022
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发表时间：
2020
影响因子：
2.8
通讯作者：
Goldstein,NathanE
中科院分区：
文献类型：
--
作者：
Kwok,IanB;Mather,Harriet;McKendrick,Karen;Gelfman,Laura;Hutchinson,MathewD;Lampert,RachelJ;Lipman,HannahI;Matlock,DanielD;Swetz,KeithM;Kalman,Jill;Pinney,Sean;Morrison,RSean;Goldstein,NathanE
背景：植入式心律转复除颤器（ICD）可降低心力衰竭（HF）高危患者的心源性猝死发生率，但这些器械的电击也会在生命结束时引起疼痛和焦虑。虽然专业社会的建议，鼓励积极主动的讨论ICD失活，临床医生缺乏培训，在进行这些对话，他们很少发生。方法：作为一个六中心随机对照试验的一部分，我们评估了教育组成部分的多组分干预显示，增加谈话ICD失活的临床医生谁照顾一个子集的晚期HF患者。这包括一个90分钟的培训讲习班，旨在提高关于ICD管理的对话的质量和频率。为了表征其效用作为一个孤立的干预，我们比较了HF临床医生的前和车间后的分数（5点李克特量表）评估自我报告的信心和技能，在特定的做法，先进的护理规划，ICD失活的讨论，和共情communication.Results：40干预组HF临床医生完成了前和车间后的调查。研讨会前的分数显示出高基线水平的信心（4.36，标准差[SD] = 0.70）和技能（4.08，SD = 0.72），而讲习班前后的分数比较显示，信心没有显着下降（-1.16，p = 0.252）和技能（-0.20，p = 0.843）。结论：我们的研究结果显示，在教育干预后，自我评估评分没有显着变化。然而，我们的数据确实表明，HF临床医生对他们在提前护理计划对话中的技能有很高的基线自我感知，并且似乎为进一步的专业发展做好了充分的准备，以改善晚期HF背景下的沟通。
Background:Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently.Methods:As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication.Results:Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (−1.16,p= 0.252) and skill (−0.20,p= 0.843) after the training session.Conclusions:Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF.