The Capacity Building programme at hospital was conducted by the Chinese University of Hong Kong (CUHK) Jockey Club Institute of Ageing (IoA) from 2015 to 2018 with a broad range of beneficiaries. The programme covered a wide variety of topics such as communication skills in serious illness conversation, symptom management in EoLC, etc. Different materials were used in education and promotion, including videos, booklets, e-cases and more.
During the period, the Institute delivered 293 educational programmes comprising 175 capacity building programmes for healthcare professionals in hospitals and RCHEs in New Territories East cluster (NTEC), 58 workshops and seminars for specific target groups, 18 public forums for stakeholders and 42 information sessions for patients and family members.
A total of 10,310 participants were benefited from the educational programmes including 728 doctors, 2,707 nurses, 2,155 healthcare staff, 539 medical students, 1,562 other specific target groups, 1,642 general public and 977 patients and family members. In this section, only the outcomes on professionals are presented. For full details of the evaluation report on the programmes in hospitals, please visit here.
A couple of evaluation studies were carried out, with each being conducted on a type of target participant. To examine if the educational programme was able to enhance health and social care workers’ self-competence in death work (by self-competence in death work scale [SC-DWS]), the CUHK distributed questionnaires to health and social care workers in RCHEs and seven hospitals in the NTEC from February 2018 to June 2018. Participants were conveniently sampled in talks, seminars, and workshops in the project. Questionnaire were also sent to the institutions by post, and an online questionnaire was provided as an alternative. For doctors who had attended communication skills training and nurses who had attended courses held by the Institute, questionnaires were distributed in training sessions to collect their quantitative responses and qualitative feedback on the training course. Regarding residential care home staff, from February to March 2018, a questionnaire survey was conducted in 5 RCHE to evaluate the effectiveness of the programme. RCHE staff who attended the training sessions of CUHK were invited to fill in a questionnaire.
The survey on 614 health and social care workers in 2018 showed that respondents who received more training provided by the Institute were more self-competent in death work, as evidenced by higher scores on the SC-DWS and its two subscales when compared to those who attended none. (Refer to the table below)
The difference in self-competence of attendees and non-attendees varied according to the type of training received (refer to the table below) with the largest benefit observed in training in symptom control (difference in means 3.19), followed by the sessions on introduction to EOL care (difference in mean 2.34)
For doctors’ communication skills training, twenty post-training questionnaires were collected from doctors in four hospitals right after the training. Percentage increases in their self-perceived preparedness in communication skills ranged from 24.6% to 40.3% (mean= 33.1%) after training when compared to before training. The largest improvement was found in the preparedness to explore goals of care with seriously ill patients or their families. Participants rated the importance of the training to the development of their clinical skills at a mean of 4.35, on a scale from 1 (not at all important) to 5 (very important). The majority (94.7%) would recommend the training to other physicians in their specialty and 89.5% agreed that all higher physician trainees in their specialty should be required to attend the training. Below are some of the direct feedbacks from the participants after attending training program:
“The training program teach us how to facilitate communication and reduce conflicts between relatives and healthcare providers.”
“(I) had benefited immensely especially in the role play and discussion.”
Over 98% of participants indicated that they will recommend similar activities to their colleagues/friends. Qualitative feedback was also obtained on the questionnaire. Respondents mentioned merits of the training. (Please see the example below)
“The topic and content are novel. The content is profound but easy to understand. The situation of end-of-life care in Hong Kong was introduced, improving my understanding of end-of-life care in Hong Kong was introduced, improving my understanding of what happens when one faces death.” (Acute Hospital C, A Better End-of-Life Care series: An Insight into Dying in Hong Kong)
“The content is rich. The information is useful and relevant to clinical work.” (Acute Hospital B, Symptom Management in End-of-Life Care)
66 staff (more than half were nurses or social workers) in RCHEs who had attended the training sessions had completed the post-training questionnaires. It was found that respondents participating in more training sessions organised by the institute had better knowledge of EoL care as manifested by a higher mean score on 10-item test (mean = 8.77 for 3 or more sessions; mean = 8.65 for two sessions; mean = 7.86 for one session). Below are some of the direct feedbacks from the residential care home staff after attending the programmes.
“Their [Residential care home staff’s] awareness [of end-of-life care] has really improved. They refer [patients] to us. Tell us the condition of some older adults. They observe and invite us to follow up. These are very helpful to us. At least, we can intervene in a timely manner, which is very important” (Social worker, attend 23 training sessions).
“[I] gain a better understanding of how to tell family member the end-of life client’s condition, and express more accurately. The accuracy id higher. Family members understand better. And for symptom control, I think[I] have a better understanding, compared to when I was on board” (Registered nurse, attended 11 training session.)
