Miller S J, Hope T, Talbot D C
University of Oxford, Department of Psychiatry, The Warneford Hospital, Headington, UK.
Br J Cancer. 1999 May;80(5-6):792-800. doi: 10.1038/sj.bjc.6690423.
There has been considerable interest in how doctors break bad news, with calls from within the profession and from patients for doctors to improve their communication skills. In order to aid clinical training and assessment of the skills used in breaking bad news there is a need for a reliable, practical and valid, structured rating schedule. Such a rating schedule was compiled from agreed criteria in the literature. Video-taped recordings of simulated consultations breaking bad news were independently assessed by three raters using the schedule and compared to three experts who gave global ratings. The primary outcome measures were internal consistency of the schedule and level of agreement between raters. The internal consistency was high with a Cronbach's alpha of 0.93. Agreement between raters using the schedule was moderate to good. The majority of the variation in scores was due to the differences in skills demonstrated in the interviews. The agreement between raters not using the schedule was poor. The BAS provides a simple to use, reliable, and consistent rating schedule for assessing skills used in breaking bad news. It could be a valuable aid to teaching this difficult task.
医生如何告知坏消息已引发了相当大的关注，业内人士和患者都呼吁医生提高沟通技巧。为了辅助临床培训以及评估告知坏消息时所使用的技巧，需要一个可靠、实用且有效的结构化评分表。这样一个评分表是根据文献中公认的标准编制而成的。使用该评分表，由三位评估者对模拟告知坏消息的会诊录像进行独立评估，并与给出整体评分的三位专家的评估结果进行比较。主要的结果指标是评分表的内部一致性以及评估者之间的一致程度。内部一致性较高，克朗巴哈系数为0.93。使用该评分表的评估者之间的一致性为中等至良好。分数的大部分差异是由于访谈中所展示的技巧差异所致。未使用该评分表的评估者之间的一致性较差。BAS提供了一个易于使用、可靠且一致的评分表，用于评估告知坏消息时所使用的技巧。它可能是教授这项艰巨任务的一项宝贵辅助工具。
