Mercer Stewart W, Maxwell Margaret, Heaney David, Watt Graham Cm
General Practice and Primary Care, Division of Community-based Sciences, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK.
Fam Pract. 2004 Dec;21(6):699-705. doi: 10.1093/fampra/cmh621. Epub 2004 Nov 4.
Empathy is a key aspect of the clinical encounter but there is a lack of patient-assessed measures suitable for general clinical settings.
Our aim was to develop a consultation process measure based on a broad definition of empathy, which is meaningful to patients irrespective of their socio-economic background.
Qualitative and quantitative approaches were used to develop and validate the new measure, which we have called the consultation and relational empathy (CARE) measure. Concurrent validity was assessed by correlational analysis against other validated measures in a series of three pilot studies in general practice (in areas of high or low socio-economic deprivation). Face and content validity was investigated by 43 interviews with patients from both types of areas, and by feedback from GPs and expert researchers in the field.
The initial version of the new measure (pilot 1; high deprivation practice) correlated strongly (r = 0.85) with the Reynolds empathy measure (RES) and the Barrett-Lennard empathy subscale (BLESS) (r = 0.63), but had a highly skewed distribution (skew -1.879, kurtosis 3.563). Statistical analysis, and feedback from the 20 patients interviewed, the GPs and the expert researchers, led to a number of modifications. The revised, second version of the CARE measure, tested in an area of low deprivation (pilot 2) also correlated strongly with the established empathy measures (r = 0.84 versus RES and r = 0.77 versus BLESS) but had a less skewed distribution (skew -0.634, kurtosis -0.067). Internal reliability of the revised version was high (Cronbach's alpha 0.92). Patient feedback at interview (n = 13) led to only minor modification. The final version of the CARE measure, tested in pilot 3 (high deprivation practice) confirmed the validation with the other empathy measures (r = 0.85 versus RES and r = 0.84 versus BLESS) and the face validity (feedback from 10 patients).
These preliminary results support the validity and reliability of the CARE measure as a tool for measuring patients' perceptions of relational empathy in the consultation.
同理心是临床诊疗过程中的一个关键方面，但缺乏适用于一般临床环境的患者评估方法。
我们的目标是基于对同理心的广泛定义开发一种诊疗过程评估方法，该方法对患者具有意义，无论其社会经济背景如何。
采用定性和定量方法来开发和验证这种新的评估方法，我们将其称为诊疗与关系同理心（CARE）评估方法。在三项全科医疗试点研究（分别位于社会经济贫困程度高或低的地区）中，通过与其他已验证的评估方法进行相关分析来评估同时效度。通过对来自这两类地区的43名患者进行访谈，以及收集全科医生和该领域专家研究人员的反馈，来调查表面效度和内容效度。
新评估方法的初始版本（试点1；高贫困地区诊所）与雷诺兹同理心评估方法（RES）（r = 0.85）和巴雷特 - 伦纳德同理心子量表（BLESS）（r = 0.63）高度相关，但分布严重偏态（偏度 -1.879，峰度3.563）。统计分析以及对20名受访患者、全科医生和专家研究人员的反馈，促使进行了一些修改。在低贫困地区测试的修订后的CARE评估方法第二版（试点2）也与既定的同理心评估方法高度相关（与RES的r = 0.84，与BLESS的r = 0.77），但分布的偏态较小（偏度 -0.634，峰度 -0.067）。修订版的内部信度较高（克朗巴哈系数0.92）。访谈时患者的反馈（n = 13）仅导致了微小的修改。在试点3（高贫困地区诊所）测试的CARE评估方法最终版证实了与其他同理心评估方法的效度（与RES的r = 0.85，与BLESS的r = 0.84）以及表面效度（来自10名患者的反馈）。
这些初步结果支持了CARE评估方法作为一种测量患者对诊疗过程中关系同理心认知的工具的效度和信度。
