醫療從業人員之專業養成過程中同理心與利社會行為之變化

Abstract

背景：同理心和利他主義是醫療倫理中核心的價值。過去同理—利他行為假設認為：人的利他行為是藉由產生同理他人之情感所引發的。然而此假設似乎並不適用於某些特定情境，例如當醫療人員過度聚焦於病患無法緩解的痛苦時，會使醫療從業人員產生無力感、缺乏自信心，導致職業倦怠、悲憫疲乏和低生活品質，進而使醫療從業人員降低醫療相關的助人行為。但目前並未有研究探討醫療人員的同理心與利社會行為兩因子間的關係，故釐清此貳因子對於醫療從業人員行為的影響非常重要。然而，過去研究多以自評式問卷來評估受試者之同理心，此法亦產生社會期待偏誤。另外，過去研究亦多著重於評估醫療從業人員之同理心，少有研究探討醫療人員的同理心與利社會行為之相關性。 目的：1. 分別使用不同的實驗典範，隱密的測試醫療從業人員的同理心與利社會行為。2. 了解醫療從業人員在經歷醫療相關訓練及臨床實習後，其同理心與利社會行為的變化。 方法：我們招收了四組受試者，每組30人，分別為：職能治療師、職能治療大一學生、控制組專業人員、控制組大一學生。我們採用語情境相關之改良型情緒史楚普實驗典範評估受試者之同理心。另外，我們亦運用電腦化蘇黎世利社會遊戲、及改良自獨裁者賽局之捐錢實驗來測驗受試者之利社會行為傾向。 結果：當醫療從業人員於醫療相關情境中，會降低他們看到悲傷臉孔的情緒反應，但此調節現象並不會在醫療無關情境中或快樂臉孔中出現。相對地，此情境特定的情緒調節機制未存在於其他專業人員或學生組中。另外，蘇黎世電腦化遊戲及捐錢實驗結果顯示：與學生組比較，醫療從業人員維持高程度的利社會行為傾向於虛擬情境及實際生活情境中，然而控制組專業人員相較於學生組，其利社會行為的傾向顯著地降低。即使控制了薪資及花費兩個混淆變項後，此結果依然顯著。 結論：結果顯示，醫療從業人員會根據情境來調節他們對於悲傷情境的情緒反應。另外，醫療從業人員可以維持如學生組一樣高程度的利社會行為。同理心和利社會行為在醫療從業人員中並未顯現正相關。此結果可能源於醫療從業人員在醫療情境中發展出特別的情緒調節系統，使其免於過於同理醫療相關的悲傷事件後產生的情緒困擾及悲憫疲乏感，以保有利社會行為，持續致力於醫療志業中。

Background: Empathy and altruism are two core values of healthcare profession. Empathy-altruism hypothesis claimed that altruistic behaviors are motivated by empathy. However, this hypothesis does not seem to hold in certain contexts. For example, over-emphasizing on patients’ unalleviated suffer may make medical professionals feel helpless and diminish their confidence which could led to burnout, compassion fatigue and low quality of life. These drawbacks could further dampen medical-related prosocial behaviors, which appears to contradict the prediction of the empathy-altruism hypothesis. Most of previous related studies in health care systems focus only on empathy without any discussion on prosocial behaviors. In addition, the traditional questionnaire based evaluation of empathy suffers from serious vulnerability to response bias due to its nature of explicit measurement. Therefore, the relationship between empathy and prosocial behaviors remains unclear. Objectives: There were two primary aims for the current research: 1. To develop effective paradigms for implicit evaluation on empathy and prosocial behavior patterns; 2. To investigate the chronological change of the relationship between empathy levels and prosocial behavior patterns in healthcare professionals. Method: Four groups of participants including occupational therapists, occupational freshmen, and two corresponding controls participated in the current study. We proposed a novel modified Emotional Stroop paradigm to implicitly evaluate empathy. Furthermore, we used computerized Zurich Prosocial Game (ZPG) and a donation paradigm modified from dictator games to implicitly evaluate of prosocial behavior patterns. Results: Health care professionals tended to show reduced emotional responses toward sad facial expression after empathizing medical-related scenarios of negative emotion. In contrast, we did not observe similar context-based emotional modulation in other control professionals and student groups. Furthermore, results from ZPG and donation experiment revealed that health care professionals maintained high degrees of prosocial behavior both in virtual game context and in real-world donation, which was not seen in control professionals Conclusion: Our results therefore suggest that the reduced emotional responses under empathizing processes of healthcare professionals is contextual oriented. On the other hand, however, they maintain high degrees of prosocial behavioral trait under reduced levels of empathy, which provides evidence against the empathy-altruism hypothesis. A possible explanation is that health care professionals modulated their empathy toward medical related negative events to protect them from personal distress and enable them to maintain their high degrees of prosocial caring behaviors