Contextualizing Care for Patients With a Serious Illness: Implementation of an Interactive Communication Training Program
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 81
- 试验地点
- 1
- 主要终点
- Change in self-assessed competence in contextualised care (measured using the Spiritual Care Competence Scale)
研究概览
简要总结
When people become seriously ill, healthcare decisions are influenced not only by their medical condition, but also by their personal situation, values, wishes, and daily life circumstances. A medically appropriate treatment may not always fit what is important or realistic for an individual. Contextualised care aims to integrate relevant aspects of a patient's life into care and decision-making.
This study investigates whether an interactive communication training program can help healthcare professionals provide more contextualised care for people with serious illness. The training aims to improve professionals' skills in recognising, exploring, and integrating relevant patient context into clinical decision-making and teamwork.
Healthcare professionals from hospital teams in the Netherlands will participate, including physicians, nurses, nurse specialists, and physician assistants caring for patients with serious illness. The training consists of two three-hour sessions. Participants will practice communication skills using realistic clinical situations and learn how patient context can be incorporated into care planning and communication within the healthcare team.
The effects of the training will be evaluated in several ways. Healthcare professionals will complete questionnaires before and after training to assess competence, communication, and job satisfaction. Responses to simulated patient situations will be analysed to examine how participants recognise and respond to patients' concerns. Medical records will also be reviewed to examine whether non-somatic aspects of care are more often documented, anticipated, and communicated after the training. Hospital-based healthcare use and associated costs will also be assessed.
The study aims to provide insight into whether training hospital teams in contextualised communication can support more personalised, appropriate, and person-centred care for people living with serious illness.
详细描述
Serious illness affects not only a person's physical health but also many other aspects of life, including daily functioning, relationships, social roles, personal identity, values, and future perspectives. As medical possibilities increase, healthcare professionals are increasingly confronted with complex decisions about treatments and care plans. In these situations, the most appropriate care is not necessarily the intervention that is optimal from a purely biomedical perspective, but the care that best fits the individual patient's medical condition together with their personal circumstances, goals, preferences, and possibilities.
Although multidimensional and person-centred care are widely recognised as important components of high-quality healthcare, clinical decision-making is often still predominantly focused on biomedical information. Relevant aspects of patients' lives may remain unidentified or insufficiently incorporated into care planning. This can result in care that does not adequately match patients' needs, priorities, or everyday realities.
This study focuses on contextualised care, an approach that aims to systematically integrate relevant patient context into healthcare communication, clinical reasoning, shared decision-making, and care planning. Within this approach, patient context refers to personal circumstances and characteristics that may influence the appropriateness, feasibility, or consequences of healthcare decisions. Relevant contextual factors may include, for example, patients' abilities and limitations, responsibilities, social circumstances, living situation, values, goals, coping strategies, preferences, and aspects of life that influence what patients consider meaningful or realistic.
The contextual care model is based on the principle that healthcare professionals should not only ask what treatment is medically possible, but also explore whether that treatment fits the person receiving it. Contextual information becomes clinically relevant when overlooking it may negatively influence healthcare decisions or outcomes. Integrating this information can support more personalised care, improve alignment between treatment plans and patients' lives, and contribute to appropriate healthcare utilisation.
Previous research has demonstrated that healthcare professionals can improve their contextual communication skills through training. However, existing interventions have mainly focused on individual healthcare professionals or specialist palliative care teams. In many healthcare systems, including the Netherlands, much care for people with serious illness is delivered by generalist hospital teams rather than specialist palliative care services. Therefore, it is important to understand whether contextualised care can be integrated into routine practice through training multidisciplinary hospital teams.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Healthcare professionals working in a hospital team in the Netherlands
- •Actively involved in the care of patients with serious illness
- •Profession: physician, nurse, nurse specialist, or physician assistant
- •Age ≥18 years
- •Dutch-speaking
- •Provided informed consent
排除标准
- •Not part of a participating hospital team receiving the training intervention
- •No informed consent provided
研究组 & 干预措施
Contextualized Care Training Intervention
Participants receive an interactive communication training program on contextualized care for patients with serious illness. The training is based on the contextual care model and aims to strengthen healthcare professionals' skills in recognizing, exploring, identifying, and integrating relevant patient context into clinical communication and care planning.
The intervention consists of two 3-hour training sessions. The first session focuses on individual communication skills, including recognizing contextual cues and exploring patients' personal circumstances, values, and priorities. The second session focuses on multidisciplinary collaboration, including integration of contextual information into care planning and communication within the healthcare team. The training uses interactive methods, including brief lectures, role-play with professional actors, simulated clinical situations, reflection, and feedback.
干预措施: Contextualized Care Communication Training (Behavioral)
结局指标
主要结局
Change in self-assessed competence in contextualised care (measured using the Spiritual Care Competence Scale)
时间窗: Baseline (4 weeks before training) to 4 and 16 weeks after training
Healthcare professionals' self-assessed competence will be assessed using selected domains of the Spiritual Care Competence Scale (SCCS), including communication, assessment, and referral competencies. The SCCS assesses healthcare professionals' perceived competence in addressing patients' multidimensional needs through communication, assessment, and appropriate support or referral. Higher scores indicate higher perceived competence. Changes from baseline to 4 and 16 weeks after the training will be assessed.
次要结局
- Change in patient- and family-centred communication competence(Baseline (4 weeks before training) to 4 and 16 weeks after training)
- Change in self-efficacy in end-of-life communication(Baseline (4 weeks before training) to 4 and 16 weeks after training)
- Change in applied competence in contextualised communication(Baseline (4 weeks before training) to 4 and 16 weeks after training)
- Change in documentation and integration of patient context in clinical practice(One year before and one year after the training intervention)
- Change in healthcare professionals' job satisfaction(Baseline (4 weeks before training) to 4 and 16 weeks after training)
- Hospital-based healthcare costs per patient in the final three months of life(Final 3 months of life)
- Hospital-based healthcare costs per patient in the final month of life(Final month of life)
- Perceived barriers and facilitators for contextualising care(Baseline (4 weeks before training) and 4 and 16 weeks after training)