The need for end-of-life care training in nephrology: National survey results of nephrology fellows
The need for end-of-life care training in nephrology: National survey results of nephrology fellows
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DOI：
10.1016/s0272-6386(03)00868-0
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发表时间：
2003-10-01
影响因子：
13.2
通讯作者：
Arnold, RM
中科院分区：
文献类型：
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作者：
Holley, JL;Carmody, SS;Arnold, RM
由于终末期肾病的死亡率很高，肾病专家照顾许多垂死的患者。然而，肾脏病学研究员在姑息治疗方面的教育尚未得到评估。我们对二年级肾脏病学研究员进行了调查，以评估他们接受的姑息医学教学的数量和质量，并询问他们对临终患者管理的准备情况。 63% 的调查回复率产生了 173 项评估调查。几乎所有研究员 (99%) 都同意医生有责任在患者临终时提供帮助；一半的人认为学习如何照顾垂死的病人非常重要。在 10 分制中，0 代表没有教学，10 代表大量教学，研究员报告说，临终关怀中的教学（平均得分，3.8 +/- 2.6）显着少于治疗远端肾小管酸中毒患者（平均得分，6.3 +/- 2.5）或血液透析治疗患者（平均得分，8.9 +/- 1.5；所有 P < 0.0001）。很少教授具体的姑息治疗内容领域；只有 22% 的研究员学会了如何告诉病人他或她快要死了。与姑息治疗专家接触过的研究员报告说，他们接受了更多关于临终问题的教育，并相信他们为提供此类护理做好了更充分的准备。研究员在研究期间的姑息治疗经历经常发生在没有参加肾脏病专家监督的情况下； 32% 的研究员召开了 2 次或更少的家庭会议，26% 的家庭会议没有肾病专家出席。研究人员认为，他们在管理接受血液透析治疗的患者方面准备得最好（平均评分为 8.9 +/- 1），而在管理临终患者方面准备最差（平均评分为 6.1 +/- 2；P < 0.0001）。我们的结果表明，大多数肾脏病学研究员认为他们应该学习如何护理垂死的患者，但大多数奖学金项目不提供这种培训。因此，我们的研究建议将姑息治疗培训纳入进修计划课程中。
Because of the high mortality rate of end-stage renal disease, nephrologists care for many dying patients. However, the education of nephrology fellows in palliative care has not been assessed. We surveyed second-year nephrology fellows to assess the quantity and quality of teaching they received in palliative medicine and also asked about their preparedness to manage patients at the end of life. A 63% survey response rate yielded 173 surveys for evaluation. Nearly all fellows (99%) agreed that physicians have a responsibility to help patients at the end of life; half thought it was very important to learn how to care for dying patients. On a 10-point scale in which 0 is no teaching and 10 is a lot of teaching, fellows reported significantly less teaching in end-of-life care (mean score, 3.8 +/- 2.6) than in managing a patient with distal renal tubular acidosis (mean score, 6.3 +/- 2.5) or on hemodialysis therapy (mean score, 8.9 +/- 1.5; all P < 0.0001). Specific palliative care content areas were taught infrequently; only 22% of fellows were taught how to tell a patient he or she is dying. Fellows who had contact with a palliative care specialist reported more education on end-of-life issues and believed they were better prepared to provide such care. Fellows' palliative care experiences during fellowship frequently occurred without attending nephrologist supervision; 32% of fellows had conducted 2 or fewer family meetings, and 26% of all family meetings occurred without an attending nephrologist. Fellows believed they were best prepared to manage a patient on hemodialysis therapy (mean score, 8.9 +/- 1) and least prepared to manage a patient at the end of life (mean score, 6.1 +/- 2; P < 0.0001). Our results show that most nephrology fellows believe they should learn how to care for dying patients, but most fellowship programs do not offer this training. Our study therefore suggests that training in palliative care be incorporated into fellowship program curricula.