Ditton-Phare Philippa, Sandhu Harsimrat, Kelly Brian, Kissane David, Loughland Carmel
Hunter New England Mental Health, Newcastle, NSW, Australia.
University of Newcastle, Newcastle, NSW, Australia.
Acad Psychiatry. 2016 Oct;40(5):768-75. doi: 10.1007/s40596-016-0560-9. Epub 2016 May 2.
Mental health clinicians can experience difficulties communicating diagnostic information to patients and their families/carers, especially about distressing psychiatric disorders such as schizophrenia. There is evidence for the effectiveness of communication skills training (CST) for improving diagnostic discussions, particularly in specialties such as oncology, but only limited evidence exists about CST for psychiatry. This study evaluated a CST program specifically developed for psychiatry residents called ComPsych that focuses on conveying diagnostic and prognostic information about schizophrenia.
The ComPsych program consists of an introductory lecture, module booklets for trainees, and exemplary skills videos, followed by small group role-plays with simulated patients (SPs) led by a trained facilitator. A standardized patient assessment (SPA) was digitally recorded pre- and post-training with a SP using a standardized scenario in a time-limited (15 min) period. Recorded SPAs were independently rated using a validated coding system (ComSkil) to identify frequency of skills used in five skills categories (agenda setting, checking, questioning, information organization, and empathic communication).
Thirty trainees (15 males and 15 females; median age = 32) undertaking their vocational specialty training in psychiatry participated in ComPsych training and pre- and post-ComPsych SPAs. Skills increased post-training for agenda setting (d = -0.82), while questioning skills (d = 0.56) decreased. There were no significant differences in any other skills grouping, although checking, information organization, and empathic communication skills tended to increase post-training. A dose effect was observed for agenda setting, with trainees who attended more CST sessions outperforming those attending fewer.
Findings support the generalization and translation of ComPsych CST to psychiatry.
心理健康临床医生在向患者及其家属/护理人员传达诊断信息时可能会遇到困难，尤其是在涉及如精神分裂症等令人痛苦的精神疾病时。有证据表明沟通技能培训（CST）对于改善诊断讨论是有效的，特别是在肿瘤学等专科领域，但关于精神科CST的证据有限。本研究评估了一项专门为精神科住院医师开发的名为ComPsych的CST项目，该项目侧重于传达有关精神分裂症的诊断和预后信息。
ComPsych项目包括一场 introductory lecture、供学员使用的模块手册以及示范技能视频，随后是由一名经过培训的主持人带领的与模拟患者（SP）进行的小组角色扮演。使用标准化场景在限时（15分钟）内对一名SP进行培训前和培训后的标准化患者评估（SPA）数字记录。使用经过验证的编码系统（ComSkil）对记录的SPA进行独立评分，以确定在五个技能类别（议程设置、核对、提问、信息组织和共情沟通）中使用技能的频率。
30名正在接受精神科专科职业培训的学员（15名男性和15名女性；年龄中位数 = 32岁）参加了ComPsych培训以及ComPsych培训前和培训后的SPA。培训后议程设置技能有所提高（d = -0.82），而提问技能（d = 0.56）下降。在任何其他技能分组中均无显著差异，尽管核对、信息组织和共情沟通技能在培训后往往有所增加。观察到议程设置存在剂量效应，参加更多CST课程的学员表现优于参加较少课程的学员。
研究结果支持将ComPsych CST推广并应用于精神科。
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