Fujimori Maiko, Shirai Yuki, Asai Mariko, Akizuki Nobuya, Katsumata Noriyuki, Kubota Kaoru, Uchitomi Yosuke
Psycho-Oncology Division,Research Center for Innovative Oncology, National Cancer Center Hospital East,Kashiwa,Chiba,Japan.
Graduate School of Clinical Psychology, Teikyo Heisei University,Toshima-ku,Tokyo,Japan.
Palliat Support Care. 2014 Oct;12(5):379-86. doi: 10.1017/S147895151300031X. Epub 2013 Nov 4.
The purposes of this study were to develop a communication skills training (CST) workshop program based on patient preferences, and to evaluate preliminary feasibility of the CST program on the objective performances of physicians and the subjective ratings of their confidence about the communication with patients at the pre- and post-CST.
The CST program was developed, based on the previous surveys on patient preferences (setting up the supporting environment of the interview, making consideration for how to deliver bad news, discussing about additional information, and provision of reassurance and emotional support) and addressing the patient's emotion with empathic responses, and stressing the oncologists' emotional support. The program was participants' centered approach, consisted a didactic lecture, role plays with simulated patients, discussions and an ice-breaking; a total of 2-days. To evaluate feasibility of the newly developed CST program, oncologists who participated it were assessed their communication performances (behaviors and utterances) during simulated consultation at the pre- and post-CST. Participants also rated their confidence communicating with patients at the pre-, post-, and 3-months after CST, burnout at pre and 3 months after CST, and the helpfulness of the program at post-CST.
Sixteen oncologists attended a newly developed CST. A comparison of pre-post measures showed improvement of oncologists' communication performances, especially skills of emotional support and consideration for how to deliver information. Their confidence in communicating bad news was rated higher score at post-CST than at pre-CST and was persisted at 3-months after the CST. Emotional exhaustion scores decreased at 3-months after CST. In addition, oncologists rated high satisfaction with all components of the program.
This pilot study suggests that the newly developed CST program based on patient preferences seemed feasible and potentially effective on improving oncologists' communication behaviors what patients prefer and confidence in communicating with patients.
本研究旨在基于患者偏好制定沟通技能培训（CST）工作坊计划，并评估该CST计划在培训前和培训后对医生客观表现以及他们与患者沟通信心主观评分的初步可行性。
基于先前对患者偏好的调查（建立访谈的支持环境、考虑如何传达坏消息、讨论额外信息以及提供安心和情感支持），并通过共情反应处理患者情绪，强调肿瘤学家的情感支持，制定了CST计划。该计划采用以参与者为中心的方法，包括一次理论讲座、与模拟患者的角色扮演、讨论和破冰活动；共两天。为了评估新开发的CST计划的可行性，对参与该计划的肿瘤学家在CST前后的模拟咨询过程中的沟通表现（行为和言语）进行了评估。参与者还对他们在CST前、CST后和CST后3个月与患者沟通的信心、CST前和CST后3个月的职业倦怠以及CST后该计划的帮助程度进行了评分。
16名肿瘤学家参加了新开发的CST。前后测量的比较显示，肿瘤学家的沟通表现有所改善，尤其是情感支持技能和如何传递信息的考虑。他们在CST后传达坏消息的信心评分高于CST前，并且在CST后3个月持续保持。CST后3个月情感耗竭得分下降。此外，肿瘤学家对该计划的所有组成部分都给予了高度评价。
这项初步研究表明，基于患者偏好新开发的CST计划似乎可行，并且在改善肿瘤学家符合患者偏好的沟通行为以及与患者沟通的信心方面可能有效。
