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首页> 外文期刊>BMC Medicine >Development and evaluation of the feasibility and effects on staff, patients, and families of a new tool, the Psychosocial Assessment and Communication Evaluation (PACE), to improve communication and palliative care in intensive care and during clinical uncertainty
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Development and evaluation of the feasibility and effects on staff, patients, and families of a new tool, the Psychosocial Assessment and Communication Evaluation (PACE), to improve communication and palliative care in intensive care and during clinical uncertainty

机译：开发和评估一种新工具“社会心理评估和沟通评估”（PACE）对工作人员，患者和家属的可行性和影响，以改善重症监护和临床不确定性期间的沟通和姑息治疗

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Background There are widespread concerns about communication and support for patients and families, especially when they face clinical uncertainty, a situation most marked in intensive care units (ICUs). Therefore, we aimed to develop and evaluate an interventional tool to improve communication and palliative care, using the ICU as an example of where this is difficult. Methods Our design was a phase I-II study following the Medical Research Council Guidance for the Development and Evaluation of Complex Interventions and the (Methods of Researching End-of-life Care (MORECare) statement. In two ICUs, with over 1900 admissions annually, phase I modeled a new intervention comprising implementation training and an assessment tool. We conducted a literature review, qualitative interviews, and focus groups with 40 staff and 13 family members. This resulted in the new tool, the Psychosocial Assessment and Communication Evaluation ( PACE ). Phase II evaluated the feasibility and effects of PACE , using observation, record audit, and surveys of staff and family members. Qualitative data were analyzed using the framework approach. The statistical tests used on quantitative data were t -tests (for normally distributed characteristics), the χ2 or Fisher’s exact test (for non-normally distributed characteristics) and the Mann–Whitney U -test (for experience assessments) to compare the characteristics and experience for cases with and without PACE recorded. Results PACE provides individualized assessments of all patients entering the ICU. It is completed within 24 to 48 hours of admission, and covers five aspects (key relationships, social details and needs, patient preferences, communication and information status, and other concerns), followed by recording of an ongoing communication evaluation. Implementation is supported by a training program with specialist palliative care. A post-implementation survey of 95 ICU staff found that 89% rated PACE assessment as very or generally useful. Of 213 family members, 165 (78%) responded to their survey, and two-thirds had PACE completed. Those for whom PACE was completed reported significantly higher satisfaction with symptom control, and the honesty and consistency of information from staff (Mann–Whitney U -test ranged from 616 to 1247, P -values ranged from 0.041 to 0.010) compared with those who did not. Conclusions PACE is a feasible interventional tool that has the potential to improve communication, information consistency, and family perceptions of symptom control.
机译：背景技术对于患者和家属的沟通和支持，尤其是当他们面临临床不确定性时，人们普遍感到担忧，这是重症监护病房（ICU）最明显的情况。因此，我们的目标是开发和评估一种干预工具，以改善ICU的沟通和姑息治疗的难度。方法我们的设计是I-II期研究，遵循医学研究理事会制定和评估复杂干预措施的指南以及（研究生命终止护理的方法（MORECare）声明），在两个ICU中，每年有1900例入院。第一阶段对包括实施培训和评估工具的新干预措施进行了建模，我们进行了文献回顾，定性访谈和由40名员工和13位家庭成员组成的焦点小组，从而产生了新的工具，即社会心理评估和沟通评估（PACE） ）。第二阶段通过观察，记录审核以及对员工和家属的调查评估了PACE的可行性和效果，使用框架方法分析了定性数据，定量数据上的统计检验为t检验（正态分布特征），χ 2 或Fisher精确检验（针对非正态分布特征）和曼恩·惠特尼U检验（用于经验评估），用于比较记录和不记录PACE的病例的特征和经验。结果PACE对所有进入ICU的患者进行个性化评估。它在入院后24至48小时内完成，涵盖五个方面（关键关系，社会细节和需求，患者喜好，沟通和信息状况以及其他问题），然后记录正在进行的沟通评估。实施计划由具有姑息治疗专长的培训计划支持。一项对95位ICU工作人员的实施后调查发现，有89％的人将PACE评估评为非常有用或普遍有用。在213个家庭成员中，有165个（78％）回答了他们的调查，三分之二的人完成了PACE。那些完成PACE的人对症状控制的满意度显着提高，并且工作人员提供的信息的诚实度和一致性（Mann-Whitney U检验的范围是616至1247，P值的范围是0.041至0.010）。不。结论PACE是一种可行的干预工具，具有改善沟通，信息一致性和家庭对症状控制的认识的潜力。

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