Discussing randomised clinical trials of cancer therapy: evaluation of a Cancer Research LTK training programme
Discussing randomised clinical trials of cancer therapy: evaluation of a Cancer Research LTK training programme
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DOI：
10.1136/bmj.38366.562685.8f
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发表时间：
2005-02-19
影响因子：
105.7
通讯作者：
Farewell, V
中科院分区：
文献类型：
--
作者：
Jenkins, V;Fallowfield, L;Farewell, V
目的评价一种旨在提高医护人员与癌症患者关于随机临床试验的沟通的培训干预措施。培训计划评估前后的设计。国家癌症研究网络、苏格兰试验网络和威尔士癌症试验网络的成员参与者101名医疗保健专业人员（33名临床医生和68名研究护士）。干预由训练有素的辅导员使用录像带和互动练习提供四个模块，涵盖与患者讨论随机临床试验的一般问题，辅助试验特有的问题，以缓解为目标的试验，以及患者强烈偏好某一治疗组的试验。在干预之前和之后，参与者被录下与扮演病人的演员讨论试验的视频。评估这些咨询是否存在良好临床实践指南所要求的信息。演员患者在每次访谈后进行评估，参与者报告了他们对试验讨论关键方面的自信。结果通过对会诊录像的分析，干预后患者在解释随机化（69 v 81，优势比2.33,P = 0.033）、检查患者理解程度（I I v 31，优势比3.22,P = 0.002）、讨论标准治疗（73 v 88，优势比4.75,P = 0.005）和副作用（69 v 85，优势比3.29,P = 0.006）等关键沟通行为的表现显著增加。参与者的自信心在所有领域都显著增加（P < 0.001）。演员患者对参与者沟通的评分在12/15个关键项目上有显著改善。结论：8小时的强化干预显著提高了参与者在交流随机临床试验时的信心和能力。
Objective To evaluate a training intervention aimed at improving healthcare professionals' communication with cancer patients about randomised clinical trials.Design Before and after evaluation of training programme.Setting Members of the National Cancer Research Network, Scottish Trials Network, and the Welsh Cancer Trials NetworkParticipants 101 healthcare professionals (33 clinicians and 68 research nurses).Intervention Four modules delivered by a trained facilitator using videotapes and interactive exercises to cover general issues about discussing randomised clinical trials with patients, problems specific to adjuvant trials, trials with palliation as the goal, and trials where patients had a strong preference for one treatment arm.Main outcome measures Before and after the intervention, participants were videotaped discussing a trial with an actor portraying a patient. These consultations were assessed for presence of information required by good clinical practice guidelines. The actor patients gave an assessment after each interview Participants reported their self confidence about key aspects of trial discussion.Results Analysis of the videotaped consultations showed that, after intervention, significantly more participants displayed key communication behaviours such as explaining randomisation (69 v 8 1, odds ratio 2.33, P = 0.033), checking patients' understanding (I I v 3 1, odds ratio 3.22, P = 0.002), and discussing standard treatment (73 v 88, odds ratio 4.75, P = 0.005) and side effects (69 v 85, odds ratio 3.29, P = 0.006). Participants' self confidence increased significantly (P < 0.001) across all areas. Actor patients' ratings of participants' communication showed significant improvements for 12/15 key items.Conclusion This intensive 8 hour intervention significantly improved participants' confidence and competence when communicating about randomised clinical trials.