Assessing competence of residents to discuss end-of-life issues.
Assessing competence of residents to discuss end-of-life issues.
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DOI：
10.1089/jpm.2005.8.363
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发表时间：
2005-04-01
影响因子：
2.8
通讯作者：
Arnold, Robert M
中科院分区：
文献类型：
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作者：
Buss, Mary Kathleen;Alexander, G Caleb;Arnold, Robert M
背景：住院医生通常负责引导患者在临终时的治疗偏好，但我们对他们在这项任务中的能力了解有限。目的：使用两种测量方法：自我评估(感知能力)和自我报告行为(行为能力)来评估住院医生与患者讨论提前指示(AD)的能力。研究教育经验与这两项能力测量的关系。设计：横断面自述问卷。研究对象：来自两所大学和一个社区的内科住院医师。结果：282名受访者(84%)平均每月参加6.2次EOL讨论。很少有居民报告说从居民(8%)或主治医生(7%)那里得到了关于他们讨论广告的能力的有用反馈。更少的人报告说，工作查房(4%)或参加查房(5%)经常是了解EOL护理的论坛。平均感知能力为3.8(范围1-5)。在多变量分析中，更高的感知能力与更高的研究生年限(p<；0.001)、让住院医生展示模范AD讨论(p<；0.001)以及较少的正规教育(p<；0.01)显著相关。行为能力与报告工作查房有助于了解在线护理(p=0.002)、较少的正规教育(p=0.02)和每个病房每月较多的在线讨论(p=0.009)显著相关。知觉能力和行为能力之间的相关性不大(r=0.25，p=0.001)，但有统计学意义。结论：许多居民认为自己有能力与患者讨论广告，但没有从事此类讨论的推荐行为。增加体验式学习可能是提高住院医师与患者讨论EOL问题能力的最有前途的方法。
BACKGROUND: Residents are often responsible for eliciting patients' treatment preferences at the end of life (EOL), yet we have a limited understanding of their competence in this task.OBJECTIVE: To assess the competence of medical residents to discuss advance directives (AD) with patients using two measures: self-assessment (perceived competence) and self-reported behaviors (behavioral competence). To examine the relationship between educational experiences and these two measures of competence.DESIGN: Cross-sectional self-report questionnaire.SUBJECTS: Internal medicine residents from two university- and one community-based program.RESULTS: The 282 respondents (84% response) had an average of 6.2 EOL discussions per month. Few residents reported having received useful feedback from a resident (8%) or an attending (7%) about their ability to discuss ADs. Even fewer reported that work rounds (4%) or attending rounds (5%) were frequently forums for learning about EOL care. Mean perceived competence was 3.8 (range, 1-5). In multivariable analyses, greater perceived competence was significantly associated with higher postgraduate year (p < 0.001), having residents demonstrate exemplary AD discussions (p < 0.001), and less formal education (p < 0.01). Behavioral competence was significantly associated with reporting that work rounds were useful for learning about EOL care (p = 0.002), less formal education (p = 0.02) and a greater number of EOL discussions per ward month (p = 0.009). The correlation between perceived and behavioral competence (r = 0.25, p = 0.001) was modest but statistically significant.CONCLUSIONS: Many residents view themselves as competent to discuss ADs with patients but fail to engage in recommended behaviors for such discussions. Increasing experiential learning may be the most promising means of enhancing residents' abilities to discuss EOL issues with patients.