三级医院主导的社区安宁缓和医疗培训模式探索及效果分析  

Exploration of training model of community hospice and palliative care conducted by tertiary hospitals and analysis of its effects

作　　者：戴晓艳[1] 成佳奇 赵小萱 沙蕊[1] 刘茜[1] 曲璇 葛楠 宁晓红 DAI Xiao-Yan;CHENG Jia-Qi;ZHAO Xiao-Xuan;SHA Rui;LIU Qian;QU Xuan;GE Nan;NING Xiao-Hong(Department of International Medical Services,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Beijing United Hospice and Palliative Cultural Center,Beijing 100102,China;Department of Geriatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院国际医疗部,北京100730 [2]北京同愿安缓文化中心,北京100102 [3]中国医学科学院北京协和医学院北京协和医院老年医学科,北京100730

出　　处：《中华老年多器官疾病杂志》2022年第11期835-839,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：中国医学科学院北京协和医学院教学改革项目(2019zlgc0119)。

摘　　要：目的探索三级医院主导的社区安宁缓和医疗培训模式,并对其效果进行分析。方法回顾性分析2021年1月至5月参加北京协和医院主导的社区安宁缓和医疗培训的37名学员的资料。采取自主学习、知识点讲解与案例讨论相结合、线上线下相结合的模式进行培训。采用自制量表对学员的培训效果及满意度进行问卷调查。采用SPSS 26.0统计软件进行数据分析。配对二分类资料采用McNemar检验,2组配对有序分类变量采用Wilcoxon秩和检验。结果培训时间持续4个月,共进行2次线下教学,线上学习总时长为3524 min。其中,线上自主慕课学习总时长为1834 min;线上带教14次,总时长为1690 min。学员平均出勤率为96.5%。与培训前相比,培训后“在与患者及其家属讨论缓和医疗的选择时,我的许多同事(医生或护士)都感觉不舒服”[(2.43±0.93)和(2.78±0.85)分]、“缓和医疗支持医师协助自杀(即安乐死)的行为”[(1.54±0.96)和(2.03±1.07)分]方面得分显著降低,“为使临终患者免于疼痛困扰,我通常会开(或要求开)足量的镇痛药”[(3.32±1.08)和(2.57±0.93)分]、“一旦知道根治性治疗不再有效,我通常会告知患者”[(3.46±0.87)和(2.95±0.85)分]方面得分显著增加,差异均有统计学意义(均P<0.05)。培训后各项缓和医疗知识回答正确率均高于培训前。在“病程决定了疼痛治疗的方法”[64.9%(24/37)和40.5%(15/37)]、“辅助疗法对于疼痛控制很重要”[100.0%(37/37)和86.5%(32/37)]、“长期使用吗啡镇痛面临的最主要的问题是药物成瘾”[45.9%(17/37)和24.3%(9/37)]及“缓和医疗的理念与积极治疗的理念是一致的”[81.1%(30/37)和43.2%(16/37)]方面比较,差异均有统计学意义(P<0.05)。学员对课程整体满意度在97.6%以上,对课程设置、知识点讲解、案例讨论、教师对案例的讲解及个人收获等5个方面的评分分别为4.94、4.95、4.94、4.94及4.96分(满分5�Objective To explore the training mode of community hospice and palliative care conducted by tertiary hospitals and analyze its effects. Methods A retrospective analysis was performed of the data from 37 participants who participated in the community hospice and palliative care training led by Peking Union Medical College Hospital from January 2021 to May 2021. Conducted online and offline, the training featured independent learning, knowledge explanation and case discussion. After the training, a questionnaire survey was conducted among the participants using self-made scale. SPSS statistics 26.0 was used for analysis, McNemar test for paired dichotomous data, and Wilcoxon signed rank test for paired ordered categorical variables. Results The training lasted for 4 months, totaling 3 524 minutes of online learning(1 834 minutes of self-study and 1 690 minutes teaching for 14 times) with an average attendance of 96.5%. Two offline teaching workshops were held during the training. Compared with before the training, the scores after the training were significantly lower in "Many of my colleagues(doctors or nurses) felt uncomfortable when discussing palliative care options with patients and their families [(2.43±0.93) vs(2.78±0.85) points] and in "Palliative care support assisted suicide(i.e. euthanasia)" [(1.54±0.96) vs(2.03±1.07) points], and significantly higher in "I usually prescribe(or am asked to) a sufficient amount of analgesics to relieve the dying patients from pain" [(3.32±1.08) vs(2.57±0.93) points] and in "I usually inform the patient once I know that radical treatment is no longer effective" [(3.46±0.87) vs(2.95±0.85) points], the differences being statistically significant. The correct rate of responses to palliative medical knowledge after the training was higher than that before the training. There were statistically significant differences(P<0.05) between before and after the training in "The course of the disease determines the method of pain management" [64.9%(24/37) vs 40.5%(15/37)], "Ad

关 键 词：三级综合医院 社区 安宁缓和医疗 培训 

分 类 号：R48[医药卫生—临床医学]