Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit.
Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit.
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DOI：
10.1155/2015/534879
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发表时间：
2015
影响因子：
1.7
通讯作者：
Mendez MP
中科院分区：
文献类型：
--
作者：
Markin A;Cabrera-Fernandez DF;Bajoka RM;Noll SM;Drake SM;Awdish RL;Buick DS;Kokas MS;Chasteen KA;Mendez MP
导言。虽然住院医生经常在重症监护病房(ICU)引导临终关怀(EOL)的讨论，但直到最近才需要在住院期间进行EOL护理培训，很少有针对ICU中EOL沟通的教育干预措施。这项研究评估了一种基于模拟的干预措施，旨在改善ICU中居民与家庭的EOL沟通技能。方法：研究方法。在一家大型城市教学医院，34名内科二年级住院医师参加了小组会议，教员接受了“VitalTalk”方法的培训。利克特量表问卷测量了干预前、干预后立即和大约9个月后的自我评估的准备情况。数据分析采用Wilcoxon秩和分析。结果。在接受调查的所有类别中，自我评估的准备情况显著改善(干预前；干预后；p值)，包括讨论坏消息(3.3；4.2；p<；0.01)，召开家庭会议(3.1；4.1；p<；0.01)，讨论治疗方案(3.2；3.9；p<；0.01)，讨论停止ICU治疗(2.9；3.5；p<；0.01)，以及表达同理心(3.9；4.5；p<；0.01)。除“表达同理心”外，所有项目的随访结果均持续改善。居民对教育质量的评价很高。结论。这项研究提供的证据表明，基于模拟的简短干预可以持久地提高居民与ICU患者家属讨论EOL护理的信心。
Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU. Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the “VitalTalk” method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis. Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean; p value), including discussing bad news (3.3; 4.2; p < 0.01), conducting a family conference (3.1; 4.1; p < 0.01), discussing treatment options (3.2; 3.9; p < 0.01), discussing discontinuing ICU treatments (2.9; 3.5; p < 0.01), and expressing empathy (3.9; 4.5; p < 0.01). Improvement persisted at follow-up for all items except “expressing empathy.” Residents rated the educational quality highly. Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents' confidence to discuss EOL care with family members of patients in the ICU.