Zandbelt Linda C, Smets Ellen M A, Oort Frans J, de Haes Hanneke C J M
Department of Medical Psychology, J3-208 Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
Soc Sci Med. 2005 Aug;61(3):661-71. doi: 10.1016/j.socscimed.2004.12.006.
A patient-centred approach is increasingly advocated and incorporated in medical education. Due to its multi-dimensionality, however, the concept of patient-centredness appears to be hard to measure and, consequently, to evaluate. The objective of this study was to develop an instrument to measure patient-centredness in line with one central dimension, i.e. physicians' explorative communication skills: the tendency to encourage (or discourage) patients to express their perspective on illness and treatment, by displaying facilitating and inhibiting behaviours. The paper describes the development of the patient-centred behaviour coding instrument (PBCI), and first results of validity and reliability of the instrument. The study was conducted in the outpatient division of an academic teaching hospital in The Netherlands, where follow-up encounters were videotaped and coded. Participants were 30 residents and specialists in general internal medicine, rheumatology and gastro-enterology, and 323 patients having a (video-taped) follow-up appointment with one of these physicians. All recorded consultations were coded using the PBCI. Statistical analyses verified the existence of two dimensions of the PBCI: facilitating and inhibiting behaviours. Interestingly, open and closed questions generally appeared to be indicative of both the facilitating and the inhibiting dimension; only open and closed questions with a psycho-social content were unambiguously classified as facilitating behaviours. Reliability of the facilitating behaviours was high, while reliability of the inhibiting behaviours was moderate. Besides infrequent observations of the inhibiting behaviours, low reliability was partly due to individual inter-rater variability. A global rating of patient-centredness appeared to correlate with the two dimensions in the expected direction: positively with the facilitating and negatively with the inhibiting dimension, indicating the convergent validity of the instrument.
以患者为中心的方法越来越多地得到倡导，并被纳入医学教育中。然而，由于其多维度性，以患者为中心的概念似乎难以衡量，因此也难以评估。本研究的目的是开发一种工具，以衡量与一个核心维度相一致的以患者为中心程度，即医生的探索性沟通技巧：通过表现出促进和抑制行为，鼓励（或不鼓励）患者表达其对疾病和治疗的看法的倾向。本文描述了以患者为中心行为编码工具（PBCI）的开发，以及该工具有效性和可靠性的初步结果。该研究在荷兰一家学术教学医院的门诊部门进行，对随访会诊进行录像和编码。参与者包括30名普通内科、风湿病学和胃肠病学的住院医师和专科医生，以及323名与这些医生之一进行（录像）随访预约的患者。所有记录的会诊均使用PBCI进行编码。统计分析证实了PBCI存在两个维度：促进行为和抑制行为。有趣的是，开放式和封闭式问题通常似乎都表明了促进和抑制维度；只有具有心理社会内容的开放式和封闭式问题被明确归类为促进行为。促进行为的可靠性较高，而抑制行为的可靠性中等。除了对抑制行为的观察较少外，可靠性较低部分归因于个体评分者之间的差异。以患者为中心程度的总体评分似乎与这两个维度在预期方向上相关：与促进维度呈正相关，与抑制维度呈负相关，表明该工具具有收敛效度。
