A systematic review of the effects of advance care planning facilitators training programs

被引:86
作者
Chan, Carmen Wing Han [1 ]
Ng, Nancy Hiu Yim [1 ]
Chan, Helen Y. L. [1 ]
Wong, Martin M. H. [1 ]
Chow, K. M. [1 ]
机构
[1] Chinese Univ Hong Kong, Nethersole Sch Nursing, Fac Med, Shatin, 6-F Esther Lee Bldg, Hong Kong, Peoples R China
关键词
Advance care planning; Palliative care; End-of-life care; Education; Training; Facilitator; Nurse; Healthcare professionals; OF-LIFE CARE; EDUCATIONAL-PROGRAM; MEDICAL-STUDENTS; END; COMMUNICATION; INTERVENTION; FAMILIES;
D O I
10.1186/s12913-019-4192-0
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
BackgroundAdvance care planning (ACP) is the process of ongoing communication among patients, family and health care professionals regarding what plans for future care are preferred in the event that patients become unable to make their own decisions. Clinicians play an important role in ACP as both initiators and decision coaches. However, lack of training for clinicians has frequently been reported as the reason for low involvement in ACP discussions - hence the present review evaluates the effectiveness of ACP training programs for healthcare professionals to guide the development of novel training programs for them in the future.MethodsA literature search for intervention studies was conducted independently by two reviewers in July 2018. Participants included all healthcare professionals working with adult patients suffering from terminal illness. The primary outcomes were the professionals' knowledge of and attitudes towards ACP, and self-perceived competence in ACP conversations. The Effective Public Health Practice Project appraisal tool was used to examine the quality of the studies included.ResultsA total of 4025 articles were identified, and ten eligible articles, covering 1081 participants, were included in the review. However, there is a lack of high quality randomized controlled trials of providing ACP training for nurses working in non-palliative care hospital settings. The overall quality of the intervention studies was moderate. All the studies included used instructional sessions in their interventions, while some contained group discussion, role-play and the use of advanced technology. The training programs increased the knowledge, attitudes towards shared decision-making, perceived communication skills, confidence, comfort and experiences concerned with discussing end-of-life (EOL) issues. Patient advocacy, job satisfaction and perceived level of adequate training for EOL care were improved. The use of decision aids' was rated as acceptable and clinically useful.ConclusionsTraining for healthcare professionals in ACP has positive effects on their knowledge, attitude and skills. The use of decision aids and advanced technology, instructional sessions with role play, training content focused on ACP communication skills and the needs and experience of patient in the ACP process, and a values-based ACP process are all those factors that made the ACP training programs effective.
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页数:14
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