“五习惯”医患沟通评价量表的构建及信效度研究  

Development,Reliability and Validity of the Five Habits Coding Scale

作　　者：王清燕 尹兰义 闫雅鑫 彭艳[3] 姚晨姣[4] 唐秋萍[2] 刘新春[1] WANG Qingyan;YIN Lanyi;YAN Yaxin;PENG Yan;YAO Chenjiao;TANG Qiuping;LIU Xinchun(International Cooperation&Exchange Office,the Third Xiangya Hospital of Central South University,Changsha 410013,China;Department of General Practice,the Third Xiangya Hospital of Central South University,Changsha 410013,China;Department of Gastroenterology,the Third Xiangya Hospital of Central South University,Changsha 410013,China;Post-graduation Medical Education Office,the Third Xiangya Hospital of Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院国际合作与交流办,湖南省长沙市410013 [2]中南大学湘雅三医院全科医学科,湖南省长沙市410013 [3]中南大学湘雅三医院消化内科,湖南省长沙市410013 [4]中南大学湘雅三医院毕业后医学教育办,湖南省长沙市410013

出　　处：《中国全科医学》2022年第16期1990-1994,2002,共6页Chinese General Practice

基　　金：美国中华医学会基金资助项目(CMBOC14-200)。

摘　　要：背景医患沟通障碍是导致医疗纠纷发生的主要原因之一。目前,我国对医务人员医患沟通能力的评价研究较少,缺乏信效度良好的评估工具。目的构建“五习惯”医患沟通评价量表(5HCS),检验其信度和效度。方法2014年3月,采用Brislin翻译法在“四习惯”医患沟通评价体系(4HCS)的基础上,形成5HCS初稿;2014年4—6月,采用德尔菲法,使用问卷分两轮征求专家意见,根据专家意见修订条目后形成5HCS定稿;2018年3月,使用新构建的5HCS对127名住院医师的医患沟通能力进行评估,通过分析其评价数据,检验量表的内部一致性、评价者间信度、内容效度和标准关联效度。结果正式版5HCS包含5个维度(“尊重示善,融洽关系”“采集信息,引导观点”“表达共情,建立信任”“风险告知,知情同意”“提供诊断,协商决策”),21个条目。量表的Cronbach'sα系数为0.716,各维度与量表总分的r值为0.524~0.692,各条目的内容效度指数(I-CVI)≥0.81,量表总分的评价者间信度r值为0.912,组内相关系数(ICC)=0.912,标准关联效度以中文版医患沟通技能评价量表(SEGUE)为标准,两个量表总分之间的r值为0.377(P<0.01)。结论5HCS具有良好的信度和效度,可将其作为我国住院医师医患沟通能力测评工具加以推广应用。Background Doctor-patient communication barrier is one of the major causes leading to medical disputes.Still,there are limited studies and rare instruments with good reliability and validity regarding doctors'ability to communicate with patients in China.Objective To construct the Five Habits Coding Scale(5HCS)and verify its reliability and validity.Methods The first draft of the Five Habits Coding Scale(5HCS)was formulated based on the Chinese version of the Four Habits Coding Scheme(4HCS)developed using Brislin's translation model in March 2014.Then from April to June 2014,the items of the first draft of 5HCS were revised in accordance with the expert consensuses obtained from two rounds of Delphi consultations,and after that,the final version of the 5HCS was developed,and utilized to evaluate 127 residents'abilities to communicate with patients in March 2018 for testing its internal consistency,inter-rater reliability,content validity and criterion-related validity.Results The final version of 5HCS consists of 21 items fell under 5 dimensions,namely"Show respect and kindness,harmonize doctorpatient relationship""Provide information,guide patients'views""Demonstrate empathy,build up trust""Risk disclosure,informed consent",and"Provide diagnostic information,shared-decision making".The Cronbach'sαof the scale was 0.716.The dimension-total correlation coefficients(Pearson correlation coefficients)ranged from 0.524 to 0.692,and the content validity index of each item(I-CVI)≥0.81.The inter-rater reliability was calculated by intraclass correlation(ICC)(Pearson coefficient=0.912,ICC=0.912,P<0.01).And the criterion-related validity was testified by comparing to the Chinese version of SEGUE(r=0.377,P<0.01).Conclusion The 5HCS has been proved to be highly reliable and valid,so it could be applied and promoted as a tool to evaluate the doctor-patient communication ability of residents in China.

关 键 词：医生病人关系 医患沟通 “五习惯”医患沟通评价量表 信度 效度 

分 类 号：R192.3[医药卫生—卫生事业管理]