| Objectives:1.A comprehensive review of national and international literature on hospice care multidisciplinary team training to sort out the content related to hospice care multidisciplinary team training.2.To investigate the current status of the comprehensive hospice care competence of multidisciplinary team in community hospitals and analyze its influencing factors.3.To understand the perceptions and training needs of the community multidisciplinary team for hospice care and to inform the subsequent construction of training content.4.To construct the training content of community-based hospice care multidisciplinary team through Delphi expert consultation method to provide reference for conducting community multidisciplinary team hospice care training.Methods:1.Part I: Literature review.Studies on hospice care multidisciplinary team training in Pub Med,Web of Science,the Cochrane Library,CNKI,Wanfang and Vip database were searched.Inclusion and exclusion criteria were developed,and data from the included literature were extracted and analyzed.2.Part II: Quantitative research.A total of 208 doctors,nurses,rehabilitation therapists,pharmacists and public health workers from 4 community hospitals were selected by convenience sampling method from April to July 2022.The survey tools were the general information questionnaire and the comprehensive end-of-life care competence scale.The measurement data of normal distribution were expressed by mean ± standard deviation,the counting data were expressed by frequency and percentage(%),independent sample T test was used between the two groups,one-way ANOVA was used between multiple groups,and multiple linear regression analysis was used for the influencing factors of comprehensive hospice care competence.3.Part III: Qualitative research.By using purposive sampling method,descriptive research methods were used to conduct semi-structured interviews with 15 physicians,nurses,rehabilitation therapists,pharmacists and public health workers from July to September 2022,and the data was analyzed using content analysis.4.Part IV: Delphi expert consultation.Based on the literature review,current survey and qualitative study,the first draft of the community-based hospice care multidisciplinary team training content was designed,and the final draft of the community-based hospice care multidisciplinary team training content was revised according to the expert opinions after consulting two rounds of experts from inside and outside the province using the Delphi expert consultation method.Results:1.Part I: Literature review.In total,7977 articles were retrieved,and 20 studies were included.Foreign countries carried out hospice care multidisciplinary team training earlier(1998),while China was relatively late(2016),and currently focused on tertiary hospitals and oncology specialty hospitals.The training content of systematic and standardized community-based hospice care multidisciplinary team is still relatively lacking.2.Part II: Quantitative research.A total of 208 community hospital multidisciplinary team members were surveyed in this study,and their comprehensive hospice care competence scores were(135.36±35.50),with the mean scores of entries in the 7 dimensions ranging from high to low: self-care(5.98±1.88),overarching values and knowledge(5.72±1.93),communication skills(5.56±1.90),patient and family symptom management and quality of life(5.27±1.87),psychosocial and community care(4.88±2.05),bereavement care(4.88±1.93),and end-of-life decision making(4.30±2.11);the results of the univariate analysis showed statistically significant differences in the comprehensive hospice care competence scores of team members with gender,years of community work,hospice training experience,hospice work experience,and end-stage patient care experience(P < 0.05);the results of multiple linear regression analysis showed that gender and community working years were the influencing factors of the comprehensive hospice care competence(P<0.05).3.Part III: Qualitative research.In this study,15 team members were interviewed,and 3 themes and 10 sub-themes were extracted: positive perceptions(including recognize the importance of community-based hospice care,willingness to receive community-based hospice care training);knowledge required for community-based hospice care(including knowledge of general medical and nursing care,knowledge of humanistic care,knowledge of psychological care,knowledge of doctor-patient communication);and barriers to community-based hospice care(including social support and promotion,hospital attention and investment,willingness and ability of team members,doctor-patient communication).4.Part IV: Delphi expert consultation.In this study,a total of 22 experts from inside and outside the province were consulted,and the effective recovery rates of the two rounds of expert correspondence questionnaires were 92.0% and 95.7%,respectively;the authority coefficients of the two rounds were 0.891 and 0.905,respectively;the coordination coefficients of the two rounds were 0.113-0.191 and0.129-0.275,respectively(all P < 0.05).After two rounds of expert consultation,all indicators were assigned a score of 4.0 or higher,and the coefficient of variation was below 0.25.The finalized content of the community-based hospice care multidisciplinary team training included 8 first-level indicators,26 second-level indicators,and 88 third-level indicators.Conclusions:1.Part I: Literature review.Training could improve hospice care multidisciplinary team knowledge,skills,career fulfillment,patient and family satisfaction,etc.The literature mainly included regional differences in hospice care multidisciplinary team training,no unified standard for team composition,certain differences in training content at home and abroad,and diversified training methods and evaluation indicators,but there is still a lack of unified standards.2.Part II: Quantitative research.The comprehensive effectiveness of community hospital multidisciplinary team hospice care was at the lower to middle level,with the lowest scores for the end-of-life decision making and the bereavement care capacity to be improved.Administrators and educators should enhance the training of community multidisciplinary team hospice care and emphasize the cultivation of talents so as to promote the development of community-based hospice care.3.Part III: Qualitative research.The community multidisciplinary team had a positive perception of hospice care,but the knowledge and skills of hospice care were weak,and systematic hospice care training was urgently needed.At the same time,the impediments to the implementation of hospice care by community multidisciplinary team were multifaceted,so managers should take measures to promote the implementation of community-based hospice care from multiple perspectives and correctly position the importance of each factor in the implementation of communitybased hospice care.4.Part IV: Delphi expert consultation.The content of the community-based hospice care multidisciplinary team training constructed in this study was enriched with high reliability,scientific validity and expert recognition,which could provide some guidance for the multidisciplinary team hospice care training in community health service center. |
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