發展及驗證成人生理職能治療實習生溝通技巧訓練方案

背景：有效溝通是職能治療 (occupational therapy, OT)實務的重要技能，影響治療的成效及品質。目前雖有少數OT相關的溝通技巧教學，但尚缺完整、適合且經實證之OT溝通介入方案可有效提升實習生之溝通技巧，影響OT溝通技巧教學與研究甚鉅。目的：發展成人生理職能治療實習生溝通技巧訓練方案 (Communication skills training program for occupational therapy interns in physical dysfunction practice, COPE)，並驗證COPE之成效。方法：本研究分二個階段：階段一、發展COPE。首先邀請專家，組成團隊發展COPE，完成COPE手冊包含教學內容、教學方式以及執行程序；接著進行專家效度驗證及臨床測試/修改，完成COPE的發展。階段二、驗證COPE之成效。在台大醫院及中山醫學大學附設醫院招募實習生、病人及臨床指導老師參與研究。實習生評估/治療新接案病人並且錄音前2次評估/治療過程，專家由錄音檔及逐字稿，給予實習生溝通技巧回饋。待研究收案結束，研究者將所有資料重新隨機分派給研究專家以Communication-skills measures for occupational therapy (COT)及Gap-Kalamazoo Communication Skills Assessment Forms (GKCSAF)評估實習生之溝通技巧，比較實驗組與對照組的差異並作為COPE之主要成效指標。次要成效指標包括病人評估與實習生自評之溝通技巧，以及實習生所治療病人的OT參與度。結果：階段一、完成具專家效度且經臨床測試的COPE，包括主要內容及流程。階段二、參與研究的實驗組實習生病人分別為21位及42位。對照組實習生與病人分別為20位及20位。每位實習生評估/治療病人後，皆獲得回饋包（包括錄音檔、逐字稿、評分表、自我反思問卷及回饋單），及專家給予一對一回饋。主要成效方面，二組實習生在COT的8個技巧均無顯著差異，僅「建立關係」，「形成共識」，及「結束會談」等3個技巧，實驗組表現有稍好的趨勢。研究專家使用GKCSAF評估整體溝通技巧，二組無顯著差異，實驗組表現稍好。另外，研究專家評估實驗組實習生之二位病人，使用COT評分，僅在「形成共識」有顯著進步(p=0.033)，達中等效應(ES =0.57)。使用GKCSAF評分，雖無顯著進步，但達中等效應(ES=0.58)。次要成效方面，病人使用GKCSAF評估，二組實習生無顯著差異；實驗組實習生無顯著進步。實習生使用GKCSAF自評，實驗組明顯比對照組溝通技巧表現佳(p<0.001)，且有大效應(ES=1.21)。實驗組實習生自評二位病人之溝通技巧也有顯著進步(p=0.001)，達中等效應(ES=0.67)。另外，研究結果顯示病人的OT參與度與實習生的溝通技巧似無關連。結論：COPE為內容完整、具備專家效度且臨床可行性高的OT溝通技巧訓練方案。主要成效方面二組實習生無顯著差異。實習生自評部分，組間及組內均有顯著差異，且達中等至大的效應值。另由實習生參與研究後的回饋得知，COPE對於實習生具有教育意義與價值。因此，COPE具備提升OT實習生臨床溝通技巧之潛能，此結果有助於OT實習生溝通技巧之教學及研究。

關鍵字

溝通技巧；職能治療；實習學生；臨床技能；成效驗證

並列摘要

Background: Effective communication is an important skill in occupational therapy (OT) practice that may increase the effectiveness and quality of therapy. Although there are a few occupational therapy-related communication skills teaching programs, there is still a lack of a complete, suitable, and proven occupational therapy communication intervention program that can improve interns' communication skills effectively. Purposes: The purposes were to develop a communication skills training program for occupational therapy interns in physical dysfunction practice (COPE), and to examine its effectiveness. Methods: This study was divided into two phases. Phase one was the development of the COPE. First, the researcher invited experts to form a panel to develop the COPE and its manual (teaching content, teaching methods and implementation procedures). Then, the panel invited additional experts to conduct validation and clinical testing/modification. Phase two was the verification of the COPE’s effectiveness. Interns, patients, and clinical instructors were recruited from the National Taiwan University Hospital and Chung Shan Medical University Hospital to participate in this study. The interns evaluated and treated the patients, who were just referred, and the contents were audio-recorded for the first 2 sessions. Experts gave feedback on the intern's communication skills based on the audio files and transcripts. Upon completion of the process, the research experts were re-randomly assigned to assess the interns’ communication skills using the Communication-skills measures for occupational therapy (COT) and Gap-Kalamazoo Communication Skills Assessment Forms (GKCSAF). The researcher compared the performance between the experimental and the control groups as the primary outcomes. Secondary outcomes included patient- and intern-report communication skills performance, as well as patient participation. Results: In phase one, the panel completed COPE with expert validity and clinical feasibility testing. In phase two, the experimental group comprised 21 interns and 42 patients; the control group comprised 20 interns and 20 patients. After evaluating a patient, each intern received a feedback package (including audio files, transcripts, evaluation scores, self-reflection questionnaires, and feedback reports), as well as one-on-one feedback from an expert. In terms of the primary outcomes, there were no significant differences between the experimental and control group across the 8 skills in the COT. The experimental group showed positive performance trends in "Building rapport", "Reaching consensus", and "Concluding the meeting". The GKCSAF_F by experts showed similar results with no significant differences between the two groups. The experimental group performed slightly better overall (ES=0.24). In addition, the interns in the experimental group, assessed using the COT, showed a significant improvement in "Reaching consensus" (p=0.033), reaching a moderate effect (ES =0.57). The GKCSAF_F results showed no significant improvements but reached a moderate effect (ES=0.58). In terms of secondary outcomes, there were no significant differences between the two groups of interns on patient-report GKCSAF scores; there were no significant improvements in the experimental group, either. Inter-report GKCSAF scores showed significantly higher communication skills in the experimental group than the the control group (p<0.001), with a large effect (ES=1.21). The interns in the experimental group also had significant improvements in their self-report communication skills (p=0.001), with a moderate effect (ES=0.67). In addition, the results of the study showed that the patients’ occupational therapy participation did not appear to be related to the interns' communication skills. Conclusions: The COPE appears to be an OT communication skills training program with complete content, expert validity, and high clinical feasibility. In terms of primary outcomes, there was no significant difference between the experimental group and control group of interns. Intern’s self-report results showed significant differences between and within the groups on the GKCSAF, with moderate to large effect sizes. In addition, the feedback from the interns showed that the COPE had educational significance and value. Therefore, the COPE has potential to improve the clinical communication skills of OT interns. The results of this study seems to be helpful for the teaching and research of communication skills of OT.

並列關鍵字

communication skill ； occupational therapy ； intern ； clinical competence ； effectiveness verification

參考文獻

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