Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.
Teikyo University Graduate School of Public Health, Itabashi-ku, Japan.
Am J Hosp Palliat Care. 2023 Oct;40(10):1114-1123. doi: 10.1177/10499091221148151. Epub 2022 Dec 27.
Responding to emotions is a key feature of U.S.-based serious illness communication skills training, VitalTalk, of which trained actors portraying seriously ill patients is a component. The cultural appropriateness and perceived utility of the actors' emotional expressions remain to be empirically evaluated outside of the U.S.
To determine the cultural appropriateness and educational utility of VitalTalk actors' emotional expressions, as perceived by clinicians.
From January 2021-April 2022, we conducted a cross-sectional study of physicians in Japan attending virtual VitalTalk training in Japanese, each session focusing on: responding to emotions (#1) and discussing goals of care (#2), respectively. We examined their perceived authenticity and utility of the actively and passively intense emotional expressions portrayed by actors in VitalTalk role-plays.
Physicians (N = 100, 94% response rate) from across Japan voluntarily attended two-session workshops and completed post-session surveys. Eighty-eight participants (88%) responded that both actively and passively intense emotions portrayed by the actors provided useful learning experiences. For session #1, the participants found actively intense emotional expressions to be more clinically authentic, compared to passively intense ones (4.21 vs 4.06 out of a 5-point Likert scale, P= .02). For session #2, no such difference was observed (4.16 vs 4.08 of a 5-point Likert scale, = .24).
Even in a culture where patients may express emotions passively, any intense and authentic emotional expressions by actors can be perceived as facilitating learning. Most participants perceived both the Name, Understand, Respect, Support, and Explore '(NURSE)' statements and Reframe, Expect emotion, Map out patient goals Align with goals and Propose a plan '(REMAP)' frameworks as useful in routine clinical practice in Japan.
回应情绪是美国基于严重疾病沟通技巧培训 VitalTalk 的一个关键特征，其组成部分之一是训练有素的演员扮演重病患者。在除美国以外的地方，还需要进行实证评估，以确定演员的情绪表达在文化上是否恰当，以及是否被认为具有教育实用性。
确定 VitalTalk 演员的情绪表达在日本临床医生眼中的文化适宜性和教育实用性。
从 2021 年 1 月至 2022 年 4 月，我们对参加 VitalTalk 日语虚拟培训的日本医生进行了一项横断面研究，每次培训分别侧重于：回应情绪（#1）和讨论护理目标（#2）。我们研究了他们对 VitalTalk 角色扮演中演员所表现出的积极和被动强烈情绪表达的真实性和实用性的看法。
来自日本各地的医生（94%的回应率）自愿参加了两期研讨会，并在课后完成了调查。88 名参与者（88%）表示，演员所表现出的积极和被动强烈情绪都提供了有用的学习体验。对于第 1 期培训，参与者认为积极强烈的情绪表达比被动强烈的情绪表达更具有临床真实性（5 分制中分别为 4.21 分和 4.06 分，P=.02）。对于第 2 期培训，没有观察到这种差异（5 分制中分别为 4.16 分和 4.08 分， =.24）。
即使在一个患者可能被动表达情绪的文化中，演员表现出的任何强烈和真实的情绪表达都可以被认为有助于学习。大多数参与者认为“命名、理解、尊重、支持和探索”（NURSE）和“重新表述、预期情绪、制定患者目标、与目标保持一致并提出计划”（REMAP）这两个框架在日本常规临床实践中都很有用。
