Merckaert Isabelle, Libert Yves, Delvaux Nicole, Marchal Serge, Boniver Jacques, Etienne Anne-Marie, Klastersky Jean, Reynaert Christine, Scalliet Pierre, Slachmuylder Jean-Louis, Razavi Darius
Unité de Recherche en Psychosomatique et Psycho-oncologie, Université Libre de Bruxelles, Bruxelles, Belgium.
Psychooncology. 2008 Mar;17(3):260-9. doi: 10.1002/pon.1233.
This study aimed to assess the impact on physicians' detection of patients' and relatives' distress of six 3-h consolidation workshops (CW) following a 2.5-day communication skills basic training (BT) program and to investigate factors associated with detection of distress.
Physicians, after BT, were randomized to CW or to a waiting list. Physicians' detection of patients' and relatives' distress was measured through differences between physicians' ratings of patients' and relatives' distress (VAS) and patients' and relatives' self-reported distress (HADS). Communication skills were analysed according to the CRCWEM.
Mixed-effects modelling of physicians' detection of patients' distress showed a positive group by time effect in favour of physicians in the CW group. Detection of patients' distress was associated negatively with patients' distress, positively with physicians' concurrent use of psychological assessment and supportive skills, and negatively with general assessment skills. Mixed-effects modelling of physicians' detection of relatives' distress showed no significant group by time effect. Detection of relatives' distress was associated negatively with relatives' distress and with general assessment skills.
CW following a 2.5-day BT are needed to improve physicians' detection of patients' distress in three-person interviews. Results indicate the need to further improve physicians' detection of relatives' distress.
本研究旨在评估在2.5天的沟通技能基础培训（BT）项目之后开展的六次为期3小时的巩固工作坊（CW）对医生察觉患者及亲属痛苦程度的影响，并调查与察觉痛苦相关的因素。
完成BT培训后的医生被随机分为参加CW组或等待名单组。通过医生对患者及亲属痛苦程度的评分（视觉模拟评分法[VAS]）与患者及亲属自我报告的痛苦程度（医院焦虑抑郁量表[HADS]）之间的差异，来衡量医生对患者及亲属痛苦程度的察觉。根据综合沟通与医患关系评估量表（CRCWEM）对沟通技能进行分析。
对医生察觉患者痛苦程度的混合效应模型分析显示，存在正向的组×时间效应，表明CW组医生更具优势。察觉患者痛苦程度与患者的痛苦程度呈负相关，与医生同时使用心理评估和支持性技能呈正相关，与一般评估技能呈负相关。对医生察觉亲属痛苦程度的混合效应模型分析显示，不存在显著的组×时间效应。察觉亲属痛苦程度与亲属的痛苦程度及一般评估技能呈负相关。
在2.5天的BT培训之后开展CW，对于提高医生在三人访谈中察觉患者痛苦程度是必要的。结果表明有必要进一步提高医生察觉亲属痛苦程度的能力。
