科研之友
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摘要
Objective: To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT).
Design: Developed to measure clinicians' communication behaviour with children and their parents/guardian, PCAT was designed according to consensus guidelines and refined at a number of stages. Volunteer clinicians provided videotaped real consultations. Assessors were trained to score communication skills using PCAT, a novel rating scale.
Setting: Eight UK paediatric units.
Participants: 19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos.
Main outcome measures: Itemised and aggregated scores were analysed (means and 95% confidence intervals) to determine measurement characteristics and relationship to patient, consultation, clinician and assessor attributes; generalisability coefficient of aggregate score; factor analysis of items; comparison of scores between groups of patients, consultations, clinicians and assessors.
Results: 188 complete consultations were analysed (median per doctor = 10). 3 videos marked by any trained assessor are needed to reliably (r > 0.8) assess a doctor's triadic consultation skills using PCAT, 4 to assess communication with just children or parents. Performance maps to two factors - "clinical skills'' and "communication behaviour''; clinicians score more highly on the former (mean (SD) 95% CI 0.52 (0.075)). There were significant differences in scores for the same skills applied to parent and child, especially between the ages of 2 and 10 years, and for information-sharing rather than relationship-building skills (2-tailed significance < 0.001).
Conclusions: The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation.
- 出版日期2010-5
