簡易檢索 / 詳目顯示

研究生: 何懿洲
He, Yi-Zhou
論文名稱: 台灣牙醫醫病關係中的醫病溝通之探究
Exploring the Doctor-Patient Communication in the Dental Care Relationship in Taiwan
指導教授: 張永達
Chang, Yung-Ta
廖培鈞
Liao, Pei-Chun
口試委員: 蘇宏仁
Su, Hung-Jen
黃盟元
Huang, Meng-Yuan
李明忠
Lee, Ming-Chung
張永達
Chang, Yung-Ta
廖培鈞
Liao, Pei-Chun
口試日期: 2023/07/24
學位類別: 博士
Doctor
系所名稱: 生命科學系
Department of Life Science
論文出版年: 2023
畢業學年度: 111
語文別: 中文
論文頁數: 56
中文關鍵詞: 牙醫課程醫病溝通醫病期望以患者為中心的醫療溝通技巧
英文關鍵詞: Dental curriculum, doctor-patient communication, patient-centred care, patient expectations, communication skills training
研究方法: 調查研究比較研究半結構式訪談法
DOI URL: http://doi.org/10.6345/NTNU202301427
論文種類: 學術論文
相關次數: 點閱:122下載:18
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 改善醫患溝通對於優化治療結果和病患滿意度具有重要意義。過去的研究結果強調了根據病患特徵制定定制溝通策略的必要性。為此,將醫患溝通教育納入台灣的牙科教育體系中成為本研究的目標,以加強以病患為中心的護理並減少衝突。本研究通過訪談和問卷調查以及比較不同國家的課程,對醫患溝通的重要性進行了描述性統計和廣義線性混合效應模型分析,涵蓋了牙醫和病患雙方的觀點。本研究共有超過600名病患參與了問卷調查,並且採訪了4名年齡在20歲以上且具有多年牙科經驗的牙醫師。牙科醫師的訪談結果均強調了醫患溝通的重要性,而病患問卷中呈現其年齡和收入與重視醫患溝通呈正相關,但與牙科助理的溝通呈負相關。這可能是由於病患更關注牙科醫師的專業知識和技能,而較少關注助理的溝通能力。牙醫師們強調了溝通教育的必要性,同時也強調了執行力的重要性。另外,本研究亦發現社會經濟地位較高和年齡較大的病人對牙醫與病患的溝通給予更高的評價,這可能是由於這些個體更加注重自我推銷,此結果進一步凸顯醫患關係的多樣性。根據本研究的調查結果,本研究建議在台灣實施醫患溝通課程,以提升牙科專業人員的溝通能力,從而改善醫療服務質量和病患體驗。基於訪談及問卷的研究結果,並參考美英日等國的牙醫課程,本研究建議在大學學習期間開展牙醫溝通教育,並繼續實踐以應對不斷變化的社會動態。這項研究的結果將有助於提高台灣的牙科教育體系,使其更加關注醫患溝通的重要性。透過專注於溝通技巧和策略的教育課程,牙科專業人員將能夠更好地與病患溝通,確保他們獲得所需的醫療護理並提高滿意度。同時,這也有助於減少衝突和誤解,建立良好的醫患關係,從而提升整體醫療體驗和治療結果。

    Improving dentist-patient communication is crucial for optimizing treatment outcomes and enhancing patient satisfaction. The research findings emphasize the necessity of developing tailored communication strategies that take into account individual patient characteristics. Thus, the aim of this study was to explore the feasibility of integrating dentist-patient communication education into the dental education system in Taiwan, with the goal of promoting patient-centered care and minimizing conflicts.

    In order to achieve this, we employed various methods including interviews, surveys, and comparative analysis of curricula from different countries. These approaches allowed us to gain insights into the significance of dentist-patient communication from both dentists' and patients' perspectives. Our survey involved over 600 patients, and we conducted interviews with four experienced dentists aged 20 or above. The dental professionals emphasized the importance of effective communication in the dentist -patient relationship, while we observed a positive correlation between patient age and income with the value placed on doctor-patient communication. However, there was a negative correlation between these factors and communication with dental assistants. This discrepancy may be attributed to patients prioritizing the dentists' expertise and skills over the communication abilities of the assistants. Dentists acknowledged the significance of communication education, underscoring the need for its implementation and effective execution.

    Based on our research findings, we recommend incorporating doctor-patient communication education into dental curricula during university studies, while continuously adapting to the ever-changing dynamics of society. Notably, individuals with higher socioeconomic status and older age displayed a greater appreciation for effective dentist-patient communication, potentially due to their inclination towards self-advocacy. This observation highlights the diverse nature of dentist -patient relationships. Taking these factors into account, we propose the implementation of comprehensive doctor-patient communication courses in Taiwan, aimed at enhancing the communication skills of dental professionals and ultimately improving the quality of healthcare services and patient experiences.

    By heeding the outcomes of this study, Taiwan's dental education system can be further enhanced, placing increased emphasis on the significance of effective doctor patient communication. Through targeted educational programs that focus on developing communication skills and strategies, dental professionals will be better equipped to establish rapport with patients, ensuring that their medical needs are met and bolstering overall satisfaction. Moreover, such initiatives will help to mitigate conflicts and misunderstandings, fostering positive doctor-patient relationships and ultimately enhancing the overall medical experience and treatment outcomes.

    第一章 緒論 1 第一節 研究目的與研究動機 3 一、研究主題 3 (一) 牙醫師對於醫病溝通的觀點與溝通策略 3 (二) 不同面向的病患對於醫病溝通的觀點 3 (三) 我國牙醫師職前訓練醫病溝通課程架構 3 第二章 牙醫師觀點 4 第一節 文獻探討 4 一、 牙醫師對於醫病溝通的觀點與溝通策略 4 (一) 牙醫師對病患的醫病溝通能力 4 第二節 研究方法 5 第三節 結果 5 第四節 小結論 7 第三章 病患觀點 9 第一節 文獻探討 9 一、不同年齡的病患選擇牙醫師時對於醫病溝通的考量 9 二、不同性別的病患選擇牙醫師時對於醫病溝通的考量 9 三、不同收入的病患選擇牙醫師時對於醫病溝通的考量 10 四、不同學歷的病患選擇牙醫師時對於醫病溝通的考量 10 五、病患家屬的溝通能力 11 第二節 研究方法 12 第三節 結果 13 一、牙醫師的醫病溝通技巧是影響您對牙醫師的選擇 14 二、牙醫師與病人家屬的溝通 17 三、牙醫助理與病患的溝通 18 四、兩項度分析結果 20 第四節 小結論 22 第四章 課程建議 23 第一節 文獻探討 23 一、牙醫師職前訓練醫病溝通課程 23 二、聯合國醫病溝通課程建議 23 第二節 研究方法 24 一、我國牙醫系發展史 24 二、美國牙醫系課程 29 三、英國牙醫系課程 29 四、日本牙醫系課程 30 第三節 結果 30 一、牙醫師醫病溝通的職前訓練課程 30 第四節 小結論 38 第五章 總結 39 引用文獻 40 附錄 44 附錄: 牙醫師訪談紀錄 44

    Beach, W. A. (2015). Doctor-patient interaction. Encyclopedia of language and social interaction, 476-493.
    Cheng, F.-C., Chiang, C.-P., & Chang, Y.-T. (2012). The influences of dental education in Japanese colonial period on the development of dentistry in post-war Taiwan. 中華民國家庭牙醫學雜誌, 6(4), 27-31.
    Cheng, F.-C., He, Y.-Z., Wang, L.-H., Chang, J. Y.-F., Liu, S.-Y., Chang, Y.-T., & Chiang, C.-P. (2022). Comparison of past and current dental school curricula for dental students of National Taiwan University. Journal of Dental Sciences, 17(3), 1169-1179.
    Cheng, F.-C., Wang, L.-H., Lin, T.-C., Chang, J. Y.-F., & Chiang, C.-P. (2022). Distributions of dentists and physicians in Taiwan during the Japanese colonial period from 1923 to 1924. Journal of Dental Sciences, 17(1), 135-144.
    Cheng, F.-C., Wang, L.-H., Ozawa, N., Chang, J. Y.-F., Liu, S.-Y., & Chiang, C.-P. (2022). Development of dental education for medical students in Taiwan during the Japanese colonial period. Journal of Dental Sciences, 17(2), 903-912.
    Cheng, F.-C., Wang, L.-H., Ozawa, N., Wang, C.-Y., Chang, J. Y.-F., & Chiang, C.-P. (2022a). Dental manpower and treated dental diseases in department of dentistry, Taipei Hospital (the predecessor of National Taiwan University Hospital) in 1923. Journal of Dental Sciences, 17(1), 170-175.
    Cheng, F.-C., Wang, L.-H., Ozawa, N., Wang, C.-Y., Chang, J. Y.-F., & Chiang, C.-P. (2022b). Dental technology of Taiwan during the Japanese colonial period. Journal of Dental Sciences, 17(2), 882-890.
    Cohen, L. K. (1981). Dentistry and the behavioral/social sciences: an historical overview. Journal of Behavioral Medicine.
    Daltroy, L. H. (1993). Doctor-patient communication in rheumatological disorders. Baillière's Clinical Rheumatology, 7(2), 221-239.
    Dwyer, J. (2003). Teaching global bioethics. Bioethics, 17(5‐6), 432-446.
    Eisenberg, E. M., Murphy, A. G., Sutcliffe, K., Wears, R., Schenkel, S., Perry, S., & Vanderhoef, M. (2005). Communication in emergency medicine: implications for patient safety. Communication Monographs, 72(4), 390-413.
    Elwyn, G., Edwards, A., & Kinnersley, P. (1999). Shared decision-making in primary care: the neglected second half of the consultation. British Journal of General Practice, 49(443), 477-482.
    Emanuel, E. J., & Dubler, N. N. (1995). Preserving the physician-patient relationship in the era of managed care. Jama, 273(4), 323-329.
    Feigal, R. J. (2001). Guiding and managing the child dental patient: a fresh look at old pedagogy. Journal of Dntal Education, 65(12), 1369-1377.
    Giubilini, A., Milnes, S., & Savulescu, J. (2016). The medical ethics curriculum in medical schools: present and future. The Journal of Clinical Ethics, 27(2), 129-145.
    Guo, S., Guo, X., Zhang, X., & Vogel, D. (2018). Doctor–patient relationship strength’s impact in an online healthcare community. Information Technology for Development, 24(2), 279-300.
    Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. Ochsner Journal, 10(1), 38-43.
    Jones, L., & Huggins, T. (2014). Empathy in the dentist-patient relationship: review and application. NZ Dent J, 110(3), 98-104.
    Li, H. Z., Koehn, C., Desroches, N. G., Yum, Y.-O., & Deagle, G. (2007). Asymmetrical talk between physicians and patients: A quantitative discourse analysis. Canadian Journal of Communication, 32(3), 417-433.
    Lyons, R. A. (2009). Understanding basic behavioral support techniques as an alternative to sedation and anesthesia. Special Care in Dentistry, 29(1), 39-50.
    Makoul, G. (2003). Communication skills education in medical school and beyond. Jama, 289(1), 93-93.
    Muhaimin, A., Hoogsteyns, M., Utarini, A., & Willems, D. L. (2020). Ethics education should make room for emotions: a qualitative study of medical ethics teaching in Indonesia and the Netherlands. International Journal of Ethics Education, 5(1), 7-21.
    Ngo-Metzger, Q., Massagli, M. P., Clarridge, B. R., Manocchia, M., Davis, R. B., Iezzoni, L. I., & Phillips, R. S. (2003). Linguistic and cultural barriers to care: perspectives of Chinese and Vietnamese immigrants. Journal of General Internal Medicine, 18, 44-52.
    Ong, L. M., De Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: a review of the literature. Social Science & Medicine, 40(7), 903-918.
    Saito, Y., Kudo, Y., Shibuya, A., Satoh, T., Higashihara, M., & Aizawa, Y. (2011). Building medical ethics education to improve Japanese medical students' attitudes toward respecting patients' rights. The Tohoku Journal of Experimental Medicine, 224(4), 307-315.
    Sbaraini, A., Carter, S. M., Evans, R. W., & Blinkhorn, A. (2012). Experiences of dental care: what do patients value? BMC Health Services Research, 12(1), 1-11.
    Slingsby, B. T., Yamada, S., & Akabayashi, A. (2006). Four physician communication styles in routine Japanese outpatient medical encounters. Journal of General Internal Medicine, 21, 1057-1062.
    Sullivan, C., Ellison, S. R., Quaintance, J., Arnold, L., & Godrey, P. (2009). Development of a communication curriculum for emergency medicine residents. Teaching and Learning in Medicine, 21(4), 327-333.
    Unesco. (2005). Universal declaration on bioethics and human rights: Unesco.
    Vann, W. (1978). Evolution of the dental school curriculum--influences and determinants. Journal of Dental Education, 42(2), 66-73.
    Veatch, R. M., & Sollitto, S. (1976). Medical ethics teaching: report of a national medical school survey. Jama, 235(10), 1030-1033.
    Wang, Y.-F., Lee, Y.-H., Lee, C.-W., Hsieh, C.-H., & Lee, Y.-K. (2022). Patient-physician communication in the emergency department in Taiwan: physicians’ perspectives. BMC Health Services Research, 22(1), 1-7.
    Worley, L., & Elder, C. (1991). Miscommunication in the medical encounter: a function of language or social roles? Australian Review of Applied Linguistics, 14(1), 17-34.
    呂碧鴻, 陳秀蓉, & 高美英. (2006). 醫學生之醫師同理心取向初探. 醫學教育, 10(4), 276-282.
    李婉怡, 吳靜宜, & 林佳慧. (2007). 醫療院所服務品質與顧客滿意之關係探討-以南部某牙醫聯盟為例. 品質學報, 14(2), 181-196.
    邱玉蟬. (2007). 醫病形象的媒體建構—醫療糾紛抬棺抗議新聞分析. 新聞學研究》,(93), 41-81.
    邱銘心, & 張家翎. (2015). 網路醫師評價之結構與內容特徵分析研究. 教育資料與圖書館學, 52(2), 157-190+ iii.
    姚秀韻. (2012). 中國大陸繼續醫學教育制度之探討─ 以糖尿病學為例. 展望與探索月刊, 10(6), 81-100.
    高淑貞, 蔡群瑞, & 何美雪. (2017). 從實務中探究遊戲治療督導團體可行之模式―整合督導與被督導者之觀點. 台灣遊戲治療學報(6), 29-64.
    張惠雯, 顏啟華, 林鵬展, & 劉立凡. (2011). 病人對預立醫囑的看法-以彰化某醫院家庭醫學科門診病人為例. 安寧療護雜誌, 16(3), 296-311.
    連雅雯, & 呂淑華. (2019). 運用自我效能照護一位年輕型中風病患之護理經驗. 榮總護理, 36(2), 204-211.
    陳韋良, 羅慶徽, 于大雄, 俞志誠, 張耀文, 周稚傑, . . . 范保羅. (2011). 醫學生至國內外服務學習之學習效益分析. 醫學教育, 15(1), 31-42.
    謝茉莉. (2017). 應用善意溝通於醫病溝通課程之行動研究. 人文社會與醫療學刊(4), 31-46.
    謝茉莉. (2019). 鷹架理論應用於醫病溝通的課程設計與成效評估研究. 人文社會與醫療學刊(6), 27-46.
    謝茉莉, & 洪利穎. (2014). 醫病溝通教學的觀念與策略. 人文社會與醫療學刊(1), 37-56.
    顏如娟, & 許明暉. (2007). 從資訊揭露與醫病雙方共同決策談醫病關係的演化. 北市醫學雜誌, 4(8), 643-649.
    釋證嚴. (2005). 生命交會在愛與感恩中. 人醫心傳-慈濟醫療人文月刊(22), 1-1.
    顧雅利, 郭倩琳, 李碧玉, 程紋貞, & 郭世明. (2014). 迷你臨床演練評量 (mini-CEX) 於護理領域之運用. 長庚護理, 25(3), 283-290.

    下載圖示
    QR CODE