Implications for practice, medical training and future research

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Strengths and limitations of the study:

There were no information bias as all information or investigation were disseminated by email to all participants. In addition no communication was experienced between the experts. No confusion bias was encountered. A selection bias was possible with regard to the 24 general practitioners who participated in the evaluation of the translation. There was possibly a question regarding their selection; there were a majority of women (66.67%). Also 79.17% of the GPs worked in a group practice and only 20.83% worked alone. The majority of the doctors worked in an urban environment (79.17%). The Polish researcher knew all of the experts and also took part in their selection: a sample distortion which is perhaps questionable. Nevertheless in a purposive sample the aim is not to achieve a representative sample but a comprehensive one and this was the case in this study.
The Delphi technique for translation presented strengths and limitations. The postulate of the Delphi technique was that individual judgment was enhanced by pooled intelligence. With the Delphi technique you could recover the collective opinion of a group of experts, whereas they weren’t physically together. The technique straddled both quantitative and qualitative realms, and it was seen as an accurate consensus technique in health research(27). The Delphi technique could contribute significantly to broadening knowledge in the medical profession, if it was used rigorously.(28)

Key points:

In medical treatment the working alliance is fundamental(29). Patient adherence and satisfaction depend on interpersonal dimensions of medical care. Physicians have to use these dimensions to improve therapeutic care(30). It is very important to have an European scale to measure the therapeutic alliance, and to translate this scale into all European languages, like Polish. Thereby, Poland can be compared with other European countries in terms of therapeutic alliance. In the case of a multinational study, it is important that Poland uses the same tool for assessment as other European countries.

Implications for practice, medical training and future research:

The WAI SR translation in Polish will be interesting for research activities, for clinical practice and for medical training. For clinical practice, the WAI SR could be used in many fields. For example, in 2013 Poland published a qualitative study about the kind of general practitioner patients needed to help them give up smoking. A more tailored approach to the patient’s needs was expected by patients. They wanted their GP to participate more in helping them to break the smoking habit. The WAI SR Polish version could be an accurate tool assessment to evaluate the quality of the therapeutic alliance during smoking cessation(31).
In a completely different field, the WAI SR Polish version could be used by postmenopausal women with osteoporosis. A Polish study from 2012 showed that patient adherence to therapy recommendations was influenced by the social skills of the physicians. A good therapeutic alliance between patient and physician eliminated the feeling of fear. Using the WAI SR Polish version could improve the interpersonal contact between the GP and the postmenopausal women in order to improve the quality of care in osteoporosis(32). In Poland, physicians feel very concerned by the physician-patient relationship. Many studies have been carried out on this subject. Patients can contribute to the personalization of their relationship with the physician. The repetition and regularity of the appointments facilitate the effective relationship and the therapeutic alliance(33). Once more, the WAI SR Polish version could be a good tool assessment to evaluate the quality of therapeutic alliance in Poland. In the field of communication skills, empathy is a fundamental element, especially in family medicine. In Poland, in a study published in 1996, 353 students, from the first and last year of medical school gave answers to a psychological questionnaire-« Emotional Empathy Scale » by A. Mehrabian and N. Epstein. The emotional aspects of empathy were evaluated by this questionnaire. It demonstrated that the level of empathy was higher in women in their first year of medicine but that there was a decrease of empathy in women after many years of medical education(34). To avoid this decrease in empathy, and to maintain good patient physician relations, it could be interesting to use the WAI SR Polish version, which is now a validated scale for measuring the therapeutic alliance in the whole of Europe, throughout medical studies in Poland.

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Table of contents :

Material and Methods
Ethics Statement
Research Team
Participant Selection
Data Collection
Participants in the study
Group of four experts
Group of 24 experts
First Delphi Round
Cultural Check
WAI SR Patient
WAI SR Therapist
WAI SR Scoring Sheet
Main Results
Strengths and limitations of the study
Key Points
Implications for practice, medical training and future research


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