臨床心理士のコンサルテーション・リエゾン活動に対する医療従事者の意識の質的検討
Purpose: In this study, we performed qualitative analysis to investigate the perception medical care providers have of psychological consultation-liaison (C-L) service in general hospitals. Methods: Two hundred forty nine medical care providers of a core general hospital in a local area completed a...
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Published in | Japanese Journal of General Hospital Psychiatry Vol. 23; no. 2; pp. 172 - 179 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | Japanese |
Published |
Japanese Society of General Hospital Psychiatry
2011
一般社団法人 日本総合病院精神医学会 |
Subjects | |
Online Access | Get full text |
ISSN | 0915-5872 2186-4810 |
DOI | 10.11258/jjghp.23.172 |
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Summary: | Purpose: In this study, we performed qualitative analysis to investigate the perception medical care providers have of psychological consultation-liaison (C-L) service in general hospitals. Methods: Two hundred forty nine medical care providers of a core general hospital in a local area completed a questionnaire consisting of three open-ended questions: the first question asked them to describe their image of the word ‘counseling,’ the second asked about their needs for C-L psychologists, and the third asked for their opinion on which clinical cases need referral to psychologists. The qualitative methods KJ technique and CQR (Consensual Qualitative Research) were used to analyze the data. Results: The image medical care providers have about counseling was categorized into the following: “Neutral,” “Giving Emotional Significance,” “Assessment,” “Personal Advice,” “Psychiatric Treatment,” “Psychotherapy (narrow sense),” “Assistance for Medical Activities,” and “Mind-reading.” The needs for C-L psychologists were categorized into “Needs for C-L System,” “Preventive Educational Approach for Health Care Providers,” “Psychological Support Approach for Patients,” “Psychological Support Approach for Patients’ Family,” and “Needs for Psychologists’ Talent for C-L Service.” Clinical cases subjects considered requiring referral to psychologists included seven disease categories, with cancer and chronic disease being the most frequently citied disease categories. There were three categories of problems for cancer patients: “Emotional Distress Problem,” “Patient-Medical Care Provider’s Relationship” and “Distress with Cancer Care Process.” When we compared cancer and chronic disease, both included not only psychological problems, but also pure therapeutic problems. In contrast, cancer patients had two unique characteristics: one was “Emotional Problems regarding Informed Consent,” and the other was “Complicated Patient-Medical Care Provider’s Relationship Problems.” Conclusion: Health care providers have various needs for C-L psychologists, but their image of counseling as psychologists’ main work is not always correct and it is partial. They expect not only counseling/psychotherapy (personal psychotherapeutic intervention), but also preventive and an educational approach for themselves for the patients’ family (consultative intervention). Some of their needs are based on excessive expectations or misunderstanding. Based on our findings, we suggest that C-L psychologists be required to provide intervention for medical care providers’ anxiety and conflict about the care they receive, and for the patient-medical care providers’ relationship in terms of cancer care early.
臨床心理士のコンサルテーション・リエゾン(C-L)活動に関する意識について医師と看護師249名のアンケート調査の自由記述回答(3種類)を対象に質的分析を行った。その結果,1.カウンセリングイメージは8カテゴリーに分類された。2.C-L活動に対してわかりやすさや身近さを望み,患者や家族への心理的援助だけでなく医療者に対する予防的かつ教育的なアプローチも望んでいた。3.依頼希望としてはがん患者が最も多く,①「情緒的問題」,②「患者−医療者関係」,③「がんの治療経過に伴う苦痛」への介入を望んでいた。慢性疾患患者とがん患者を比較すると,いずれも心理的問題だけではなく身体治療上の問題もあげられていた。がん患者の特徴としては,告知にまつわる情緒的問題や,複雑な患者−医療者間の相互関係があった。よってがん医療では,関係性の文脈を踏まえた後方支援的な心理的援助も行っていく必要があると考えられた。 |
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ISSN: | 0915-5872 2186-4810 |
DOI: | 10.11258/jjghp.23.172 |