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家长参与和医生-家长沟通在儿童白血病知情同意过程中。

Parent participation and physician-parent communication during informed consent in child leukemia.

机构信息

Department of Psychology, Case Western Reserve University, Cleveland, OH, USA.

出版信息

Pediatrics. 2011 Dec;128(6):e1544-51. doi: 10.1542/peds.2010-3542. Epub 2011 Nov 7.

Abstract

OBJECTIVE

In this study we evaluated the effectiveness of a physician-directed intervention at enhancing positive physician behaviors and communication strategies during informed consent conferences (ICCs) for pediatric acute leukemia clinical trials.

PATIENTS AND METHODS

Physicians at 2 large pediatric hospitals were recruited to participate in a physician-directed intervention (PDI), which included 1 full-day seminar and successive half-day booster sessions. ICCs were then observed, audiotaped, coded, and analyzed to evaluate the effectiveness of the intervention. Data also were collected at 2 control sites. Between 2003 and 2007, 59 ICCs were observed and analyzed.

RESULTS

Significant group differences were found in physician rapport-building behaviors. Physicians in the PDI + booster session group engaged in greater rapport-building than did physicians in the PDI group who did not attend booster sessions and physicians in the control group. No group differences were detected for physician partnership-building. In addition, parents in the PDI + booster session group engaged in more general communication and study-related communication, and mothers in the PDI groups asked significantly more questions per minute than did mothers in the control group.

CONCLUSIONS

These results provide support for the effectiveness of the PDI at enhancing positive physician behaviors. Booster-session attendance is a critical component of physician-directed interventions to improve parental participation and physician-parent communication during ICCs.

摘要

目的

本研究评估了一种医师主导干预措施在增强儿科急性白血病临床试验知情同意会议(ICCs)中积极的医师行为和沟通策略方面的有效性。

患者和方法

我们招募了 2 家大型儿科医院的医师参与医师主导的干预(PDI),其中包括 1 天的全面研讨会和随后的半天强化课程。然后观察、录音、编码和分析 ICC,以评估干预的效果。在 2 个对照点也收集了数据。在 2003 年至 2007 年间,观察和分析了 59 次 ICC。

结果

在医师建立融洽关系的行为方面,发现了显著的组间差异。参加 PDI +强化课程组的医师比未参加强化课程的 PDI 组医师以及对照组医师建立了更多的融洽关系。在医师建立伙伴关系的行为方面没有发现组间差异。此外,参加 PDI +强化课程组的家长进行了更多的一般性交流和与研究相关的交流,而 PDI 组的母亲每分钟提问的次数明显多于对照组的母亲。

结论

这些结果为 PDI 增强积极的医师行为的有效性提供了支持。强化课程的参与是改善 ICC 期间家长参与和医师-家长沟通的医师主导干预措施的关键组成部分。

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