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Preliminary Effects of Truth-telling Training
著者:唐婉如(Woung-Ru Tang) ;陳冠宇(Guan-Yu Chen) ;徐聖輝(Sheng-Hui Hsu) ;方俊凱(Jun-Kai Fang)
關鍵字:病情告知 ; 癌症 ; SHARE模式 ; truth telling ; cancer ; SHARE Model
摘要: 中文摘要PDF ; 英文摘要PDF

背景:癌症自1982年來一直位居十大死因之首,臨床上每日有許多癌症病人與家屬需要醫師告知病情,由於缺乏實證研究資料,病情告知的品質無法得知。日本SHARE Model溝通技巧訓練(Communication Skill Training, CST)是透過嚴謹的質性與量性研究,以癌症病人對病情告知的喜好為依據設計而成。由於台灣與日本在文化上較為接近,因此以SHARE Model為核心的標準化病情告知訓練,可能較符合本土之需求。本研究旨在測試以SHARE Model為核心的CST是否能提升參與學員的病情告知能力。 方法:本研究採單組前後測設計(Pre-post test one group design),研究對象來自台灣北、中、南、東共74名醫護人員,評估CST是否會提升參與學員的病情告知能力,及訓練時數不同是否會造成能力進步的差異。 結果:參與CST的學員,在病情告知整體能力的前後測比較上,發現統計上的顯著差異(t=12.716, p<0.0005,),病情告知能力的提升呈現極大的效益(Large effect, d=1.488),尤其在告知方法、情緒支持、及提供訊息等三個次量表上,進步更是明顯(p<0.0005)。雖然接受12小時CST學員之病情告知進步分數在後測上優於接受6小時CST訓練的學員(M=22.18 vs M=21.16),但兩組分數並未達到統計上的顯著差異(p=0.728)。 結論:以日本SHARE Model為核心的溝通技巧訓練能明顯提升醫護人員的病情告知能力。由於本研究只在CST課程結束後立即做後測,因此無法得知CST對醫護人員病情告知的長期效益。次外,本研究僅以參與學員的主觀自我評量為依據,未來若可透過癌症病人及其家屬和其他健康從業人員對參與學員的360度評量(360-degree assessment),將更客觀呈現CST的效益。
Background: Cancer has been the leading cause of death since 1982. In everyday clinical practice, many cancer patients and their family need to hear the truth from doctors. However, due to a lack of empirical research data, the quality of truth-telling is not known. The Japanese SHARE Model of Communication Skills Training (CST) was designed based on strict qualitative and quantitative studies of cancer patients' truth-telling preferences. Because Taiwan's culture is similar to Japan's, a truth-telling training model based on the Japanese SHARE Model may better meet local needs. The main purpose of this study was to test whether a SHARE Model-based CST could improve the participants' truth-telling ability. Method: The one group pre-post test design was adopted in this study and the subjects consisted of 74 medical and nursing staff from northern, central, southern, and eastern Taiwan. This study assessed whether CST could improve participants' truth-telling ability and whether a difference in training hours resulted in a difference in progress in ability. Results: Comparison of overall truth-telling ability pre-test and post-test (immediately after the CST training) revealed a pronounced effect (d=1.488) and statistically significant difference (t=12.716, p<0.0005). The improvement of subscale scores in truth-telling methods, emotional support, and provision of information was particularly significant (p<0.0005). Although the overall truth-telling scores of participants receiving 12-hour CST training were better than those of participants receiving 6-hour CST training (M=22.18 vs M=21.16), this difference was not statistically significant (p=0.728). The internal consistency of the Japanese Truth Telling Overall Scale (Chinese Version) was 0.86, suggesting that the reliability was high. Conclusions: The Japanese SHARE Model-based CST significantly increased the truth-telling ability of medical and nursing staff participating in this study. Because the post-tests were performed immediately after the CST courses, information on the long-term effects of CST on the truth-telling ability of medical and nursing staff could not be obtained. In this study, only a subjective self-assessment of participants was performed. In order to present the effects of CST more objectively, a 360-degree assessment from cancer patients, their family, and other health-related personnel has to be made.


以照顧癌末病人之醫學倫理,建構醫師靈性成長課程/ 方俊凱賴明亮呂欣芹林明慧李佩怡
病情告知訓練的初步效益/ 唐婉如陳冠宇徐聖輝方俊凱
Improvement of Bone Metastases of a Case with Female Breast Cancer by Combined Zoledronic Acid Treatment/ Yen-Min HuangTsung-Han WuCheng-Hsu WangJen-Seng Huang
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Contralateral Axillary Sentinel Lymph Node Uptake for Local Recurrence of Breast Cancer after Breast Conservation Therapy/ Shuo-Hui HungSu-Mei ChenSheng-Huang Hsiao
意義中心團體心理治療的介紹與評述/ 石世明徐聖輝

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