Clinical effectiveness of online training in palliative care of primary care physicians

BACKGROUND

Primary care physicians (PCPs) have a major responsibility in the management of palliative patients. Online palliative care (PC) education has not been shown to have a clinical impact on patients that is equal or different to traditional training.

OBJECTIVE

This study tested the clinical effectiveness of online PC education of physicians through impact on symptom control, quality of life (QOL), caregiver satisfaction, and knowledge-attitude of physicians at 18 months of the intervention.

METHODS

We conducted a randomized clinical trial. Subjects were 169 physicians randomly assigned to receive the online model or traditional training. Consecutive patients with advanced cancer requiring PC were included. Physicians and patients completed the Palliative Care Outcome Scale (POS), and patients the Brief Pain Inventory (BPI) and the Rotterdam Symptom Checklist (RSCL) twice, 7 to 10 days apart. Caregivers completed the SERVQUAL. Physicians' level of knowledge-attitude was measured at 18 months.

RESULTS

Sixty-seven physicians enrolled 117 patients. The intervention group had reduced scores for pain, symptoms, and family anxiety. The global RSCL scale showed a difference between groups. There was no significant difference in the questionnaires used. Caregiver satisfaction was comparable between groups. Physicians in the intervention group significantly increased their knowledge without any differences in attitude. Online training was completed by 86.6% in the intervention group, whereas 13.4% in the control group accessed traditional training.

CONCLUSIONS

Participation in an online PC education program by PCPs improved patient scores for some symptoms and family anxiety on the POS and also showed improved global QOL. Significant differences were found in physicians' knowledge at short and long term.

Reliability and concurrent validity of the Palliative Outcome Scale, the Rotterdam Symptom Checklist, and the Brief Pain Inventory

BACKGROUND

Some domains of the questionnaires used to measure symptoms and quality of life (QOL) in patients with advanced cancer seem to measure similar dimensions or constructs, so it would be useful for clinicians to demonstrate the interchangeability of equivalent domains of the questionnaires in measuring the same constructs.

OBJECTIVE

This study investigated the reliability and concurrent validity of the Palliative Outcome Scale (POS), the Rotterdam Symptom Checklist (RSCL), and the Brief Pain Inventory (BPI), used to measure symptom control in patients with advanced cancer.

DESIGN

This was an evaluative study.

SETTING/SUBJECTS

Subjects were patients with advanced cancer attended by Spanish primary care physicians.

MEASUREMENTS

Secondary analysis was performed of 117 outpatients who completed the POS, BPI, and RSCL at two different times, with an interval of 7 to 10 days. Bland and Altman analyses and plot, repeatability coefficient, as well as Spearman correlations were carried out.

RESULTS

There were 117 included patients. Mean age was 69.4 (11.5) years, gender was 60% male, 37.6% completed only elementary school, diagnoses were mainly digestive and lung cancer, with a low functional rate and presence of oncologic pain. First and second questionnaire rounds showed significant correlations and agreement. Agreement was shown between pain intensity of BPI and pain and physical scales of RSCL, and between physical symptoms of RSCL and of POS, with significant correlations in equivalent dimensions.

CONCLUSION

BPI, POS, and RSCL have shown adequate reliability and moderate concurrent validity among them.

Feasibility analysis of a personalized training plan for learning research methodology

OBJECTIVES

To determine the performance in learning clinical research methodology (CRM) by means of the Keller Plan (KP), to assess its impact on attitudes towards research (AR) and to estimate its acceptability.

DESIGN

An educational intervention trial was employed with control group (CG) and random assignment.

SETTING

The Family and Community Medicine Teaching Unit in Valencia, Spain, 1997.

SUBJECTS

Third-year family residents.

RESULTS

In the KP both specific written self-teaching material and interactive computer programme were used, focusing on the tutored resident, with compulsory assessments to continue. In the CG a conventional course was followed. Knowledge of CRM and the AR test (previously validated in another study) were measured at the start. Four tests of successive knowledge, time spent studying, tutorials, final AR test and acceptability were conducted. Non-parametric tests were used. Forty (89%) residents participated, 22 were assigned to KP and 18 to CG. Similar basic characteristics, with exception of AR test (medians 55 Keller, 58 control). KP knowledge tests significantly higher (P = < 0.05) than the CG (medians 101, 88) along with time spent studying (medians 53, 23.4 h). There were no significant differences in AR test, although there was an improvement in both groups, significant in KP but not in CG (median increase of 4.5 and 2). Nine residents used and positively assessed the computer programme. Better acceptability was obtained by the KP in overall evaluation, recommendation of the method and learning dynamic.

CONCLUSIONS

The KP obtained better knowledge, motivated studying and was positively accepted.