Autorisation D'imprimer

Professeur C Berthou Professeur

J Y Le Reste

SERMENT D'HIPPOCRATE

Au moment d'être admis à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité.

Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux, individuels et sociaux.

Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité.

Même sous la contrainte, je ne ferai pas usage de mes connaissances contre les lois de l'humanité. J'informerai les patients des décisions envisagées, de leurs raisons et de leurs conséquences. Je ne tromperai jamais leur confiance et n'exploiterai pas le pouvoir hérité des circonstances pour forcer les consciences.

Je donnerai mes soins à l'indigent et à quiconque me le demandera. Je ne me laisserai pas influencer par la soif du gain ou la recherche de la gloire.

Admis dans l'intimité des personnes, je tairai les secrets qui me seront confiés. Reçu à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs.

Je ferai tout pour soulager les souffrances. Je ne prolongerai pas abusivement les agonies. Je ne provoquerai jamais la mort délibérément.

Je préserverai l'indépendance nécessaire à l'accomplissement de ma mission. Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés. J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité.

Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses ; que je sois déshonoré et méprisé si j'y manque.

A Monsieur le Professeur Jean-Yves Le Reste :

Merci pour vos conseils avisés tout au long de ce travail, ainsi que pour votre disponibilité. Pour me faire l'honneur de juger mon travail, soyez assuré de tout mon respect et de ma profonde reconnaissance.

A Monsieur le Professeur Christian Berthou :

Merci de me faire l'honneur d'être membre du jury de cette thèse. Merci également pour votre disponibilité et votre investissement avec les étudiants de la faculté de Brest. Soyez assuré de ma sincère reconnaissance et de mon profond respect.

A Monsieur, le Docteur Patrice Nabbe :

Merci de l'intérêt que vous avez porté à mon travail en acceptant d'être membre de mon jury. Soyez assuré de tout mon respect et de ma reconnaissance.

A Madame le Docteur Elize Campillo :

En acceptant d'être membre de ce jury, tu me fais un grand honneur. Sans écrire de nombreux remerciements à ton égard, tu comprendras certainement que cette invitation en fait office. Après avoir été une belle rencontre professionnelle, c'est maintenant une amitié sincère. Merci pour ces fous rires pendant notre semestre de médecine interne qui rendaient le quotidien plus léger et qui ont contribué à garder un excellent souvenir de mes premiers pas en tant qu'interne.

Je te souhaite d'être heureuse et épanouie dans ta vie professionnelle et personnelle !

Ma famille et mes amis A mes parents :

Merci de votre soutien pendant toutes ces années. Vous m'avez portée et supportée jusque-là. Je sais que ça n'a pas toujours été facile. Je vous remercie de m'avoir transmis par mon éducation cette force et cette rigueur dans le travail ainsi que cette humilité au quotidien. Je retrouverai ces valeurs tout au long de ma carrière et de ma vie. Papa, après avoir dit que tu as passé l'ECN, tu peux maintenant dire que tu es thèsé ! A Amélie et Vincent, ma soeur et mon frère :

Malgré ma place d'aînée je ne pense pas vous avoir toujours montré le bon exemple.

Vous ne me contredirez pas j'en suis certaine ! Merci pour ces moments de rigolade et d'insouciance partagés ensemble et qui pendant toutes ces années difficiles me permettaient de prendre du recul sur le quotidien. Parfois la simplicité est la meilleure des philosophies de vie. Je suis fière de ce que vous êtes devenus, ne changez pas et encore merci.

A mes grands-parents, et à Maryse : Merci pour votre présence.

A Caroline : Pour ton soutien inconditionnel et à ta présence depuis toutes ces années.

A mes amis : Merci de votre soutien.

A Madame Davorina Petek, ma correspondante slovène :

Pour votre collaboration sans faille tout au long de cette étude, merci pour votre réactivité au cours de nos échanges. J'espère pouvoir un jour visiter votre pays et vous remercier de vive voix.

Aux experts slovènes : Merci pour votre participation.

Au groupe de thèse :

Pour ces réunions mensuelles qui permettaient de progresser mutuellement en faisant part de nos difficultés et de nos remarques. Merci particulièrement à Adrien pour tes compétences en informatique qui m'ont grandement aidées et sans lesquelles je serai toujours en train de rédiger ma thèse à l'heure actuelle… A Florence, James, Soizig, Adrien, Antoine, Benjamin…ces médecins urgentistes et ceux que j'oublie : Merci à vous de m'avoir transmis votre passion et votre savoir. Je m'engage dans une spécialité certes difficile, souvent ingrate mais j'en ai la foi. Je ne regrette jamais ce choix et vous n'y êtes pas pour rien. Merci pour tous ces bons moments en garde et en stage. Plus qu'un métier pour moi, c'est également une passion que je découvre tous les jours un peu plus et que j'espère à mon tour transmettre un jour.

A tous les patients rencontrés depuis le début de ces années de médecine : Merci à vous, pour ces instants de joie, d'angoisse et de tristesse, confrontée à vos difficultés j'ai acquis de la maturité et du recul sur la vie.

Abstract

Introduction:

Therapeutic alliance (TA) is a fundamental concept based on communication skills. It is defined a quality as the relationship between physician and patient with the objective to enhance observance. It is of importance for the follow up of chronic diseases. The lack of European data on the subject promoved this study. A systematic literature review and a RAND/UCLA Appropriateness Method identified the Working Alliance Inventory Short Revised (WAI-SR) as the most appropriate scale to evaluate the TA (according to its reproducibility and reliability). The purpose of this study was to achieve the translation of the WAI-SR in Slovenian, according to a forward-backward translation and a Delphi consensus procedure.

Method:

A research group composed of therapists and bilingual experts produced a forward translation. Slovenian general practitioners (GPs) validated it using a Delphi procedure. After obtaining a consensus, two independent translators worked together to carry out a backward translation. They had especially to take care of linguistic differences.

Introduction

Knowledge:

Medicine is an old science. Along time a numerous changes happened within medicine. Those changes were technical but also, on knowledge and on communication skills. [START_REF] Moujmid-Ferdjaoui | La relation médecin-patient, l'information et la participation des patients à la décision médicale: les enseignements de la littérature internationale[END_REF][START_REF] Rodgers | Therapeutic alliance in psychotherapy: the contribution of empirical research[END_REF][START_REF] Fuertes | The physician-patient working alliance[END_REF]. Within communication skills, therapeutic alliance (TA) is an interesting concept to help communication and share decision making. It is a tacit contract between patients who need care and physicians who have knowledge.

Many studies showed that therapeutic alliance (TA) has a positive effect on quality of care and adherence. [START_REF] Sylvia | Association between therapeutic alliance, care satisfaction, and pharmacological adherence in bipolar disorder[END_REF]. The concept of TA has been developed at first for psychotherapy. ( 5) It was a predictive factor of an efficient implication of the patient in care. It decreases depression symptoms in pharmacotherapy. [START_REF] Weiss | The role of the alliance in the pharmacologic treatment of depression[END_REF]. Despite of interpersonal variability, TA is a key point in medical care of chronic disease in both adults and child population. The European population ageing increases chronic illness (hypertension, diabetes…) from which adherence to treatment decrease multimorbidity. [START_REF] Cramm | The importance of productive patient-professional interaction for the well-being of chronically ill patients[END_REF] In December 2016, a study showed that a robust therapeutic alliance was strongly associated with patient engagement in weight management program. [START_REF] Sturgiss | Therapeutic alliance and obesity management in primary care -a cross-sectional pilot using the Working Alliance Inventory[END_REF] With social and cultural evolution, paternalistic model decreased. ( 9) Actually, medical decision should be shared between patient and physician. [START_REF] Elwyn | Implementing shared decision making in the NHS[END_REF] [START_REF]Communication with patients suffering from serious physical illness[END_REF]. The easy access to the information (internet, press) masked the differences which existed between patient and physician. It is nowadays a partnership based on trust in which physician develop empathy, communication, and listening. The listening is an indicator of patient's satisfaction.

Purpose of the study:

During the medicals undergraduates, students have not much teaching on communication. [START_REF] Bioy | L'alliance thérapeutique : historique, recherches et perspectives cliniques[END_REF] However, it is a fundamental aspect of consultation while enhancing mutual understanding and patient empowerment. The physician has to be self-aware, his values and his feelings. The skills can be improved thanks to programs of specifics learning. In Slovenia, communication teaching with practice, has permitted to the students to be more competent. They have developed professional skills for their future job, like empathy. Their cares corresponded better to their patients' expectations [START_REF]Teaching communication at the medical school in Ljubljana. Petek Šter M[END_REF]. Another study confirmed that patients satisfied with their physician, recommended him to their family (14). Personal continuity of care is associated with a lower discrepancy between the opinions of patients and physicians.

Therapeutic alliance is a qualitative concept; some components are complex to evaluate. It is the main difficulty. Nevertheless, it governs by an ethical and legal framework. (15). From those facts was born the Tool Assessment for Therapeutic Alliance (TATA) group within the European general practice research network. In the absence of gold standard this group aimed to find the most validated tool to measure therapeutic alliance around Europe. In 2013, a systematic literature review identified six scales to measure therapeutic alliance in adults [START_REF] Noël | Revue systématique de la littérature sur les moyens d'évaluation de l'alliance thérapeutique par des outils de mesure fiables et reproductibles[END_REF]. In September 2014 eight experts in the field of general practice, linguistics and psychology showed that the Working Alliance Inventory-Short Revised (WAI-SR) was the most efficient and easy to use tool evaluating therapeutic alliance across Europe for general practitioner [START_REF] Melot | Quelle échelle de mesure fiable et reproductible chez l'adulte pour l'alliance thérapeutique ? Sélection d'un outil par méthode de consensus RAND/UCLA. Communication orale au 9ème congrès de la médecine générale[END_REF].

The choice of the scale was made according to a RAND/UCLA consensus. The WAI-SR is feasible, reproducible and reliable.

The purpose of the study was to undertake the translation of the WAI-SR in Slovenian, according to a forward-backward translation and a Delphi consensus procedure.

Methodology

Research Group:

The study was led by a group from the medicine school of Brest who had a meeting once a month. The group included General Practitioners (GPs) trainees and senior researchers from the department of general practice. The group was instituted with the objective of exchange about difficulties. Student was in contact with a local Slovenian investigator who centralized the information.

Consensus procedure:

A forward-backward translation from English to Slovenian was selected to avoid languages differences. Thereafter, the study used a Delphi consensus procedure to ensure reproducibility in Slovenia. The advantage of this method was to try to prevent leader effect and extreme ideas.

Forward translation:

In first place, the local investigator had to find a team of four people (one linguist, one GP, one psychologist and one official translator) to translate the WAI SR from English to Slovenian. They had to have a fluid level in English. Their agreement was notified. This translation was carried out between October and November 2016.

Validation of the Forward translation:

From November 2016 to Mars 2017 a Delphi consensus procedure was undertaken to fulfill the confirmation (forward-backward translation's method) [START_REF] Sumsion | The Delphi technique: an adaptive research tool[END_REF]. A group of 30 GPs experts had to validate or not the translation by ordering each proposition from 1 (absolutely no agreement) to 9 (fully agreement). They had to explain why they did not agree under 7, using a short commentary. A local investigator centralized the answers.

Each expert was contacted independently by emails to avoid contamination between experts.

The consensus was defined as at least 70% of the participants rating 7 or above the consensual items. If an item was not validated the local investigator had to propose a new proposition taking into account, the maximum of proposals and sent it again to the group. [START_REF] Sumsion | The Delphi technique: an adaptive research tool[END_REF]. The questioning was modified until a consensus was obtained. They gave their consent previously. It was a classical Delphi consensus procedure. This methodology was frequently used in primary health care all around Europe (19-20-21).

Backward Translation:

It was designed by two people who speak English fluently. They were independent from the beginning group and they had no knowledge of the initial translations.

Ethical committee: The study was approved by ethical committee of the « université de Bretagne occidentale » in October 2014. First Delphi round:

Results

Characteristics

1 0 0 1 1 0 1 0 5 0 0 0 1 2 0 0 1 0 1 0 1 0 0 0 0 1 3 0 1 0 0 1 0 1 0 0 0 1 1 4 0 0 1 1 0 1 0 3 5 0 0 1 5 0 1 0 1 0 1 0 1 4 0 0 1 6 1 0 0 1 0 1 0 15 252 0 0 1 7 1 0 0 1 0 1 0 8 40 0 0 1 8 0 0 1 0 1 1 0 0 0 0 0 1 9 0 1 0 1 0 1 0 15 400 0 0 1 10 0 1 0 0 1 0 1 0 3 0 0 1 11 0 0 1 1 0 1 0 16 247 0 0 1 12 0 1 0 1 0 1 0 0 20 0 1 1 13 0 1 0 1 0 1 0 19 96 0 0 1 14 0 0 1 1 0 0 1 1 6 0 0 1 15 0 0 1 1 0 1 0 11 118 0 0 1 16 0 1 0 0 1 1 1 2 0 0 1 17 1 0 0 1 0 1 0 1 5 0 1 1 18 0 0 1 1 0 0 1 0 0 0 0 1 19 0 0 1 1 0 1 0 1 98 0 0 1 20 0 0 1 0 1 0 1 0 1 0 1 1 21 0 0 1 1 0 1 0 5 5 0 0 1 22 0 1 0 1 0 1 0 5 10 0 0 1 23 0 1 0 1 0 1 0 3 6 0 0 1 24 0 1 0 0 1 1 0 1 2 0 0 1 25 0 0 1 1 0 1 0 55 200 0 0 1 26 0 0 1 0 1 0 1 3 1 0 0 1 27 0 0 0 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 26
From November to the end of January, the experts had to validate the forward translation. The question n° 8 in WAI-SR patient, and the question n°2 and n°10 in WAI-SR family physician were not consensual. (table 2 and3). They generated many comments (annex 3). From February, the initial translation was modified by considering the various remarks then submitted to the experts (table 4). In the absence of answer, they were boosted by two e-mails and a phone call, but all experts of the first Delphi round answered for the second round. The Slovenian version validated after the second Delphi round was presented in annex 4.

Backward Translation:

It was realized by two linguists. The back translators were two professional translators.

They worked independently and they came to consensus in two or four rounds for the scoring sheet.

The backward translation was presented in annex 5.

Cultural Check:

The original English version was compared to the backward translation to look for mismatches creating a change of meaning. The cultural check did not show significant differences. It could not be the same as the original English version as Slovenian language was Slavic group of languages which used different structure and order of the words in the sentence. Nevertheless, the meaning was the same. The working final version will be the version validated after the second round.

WAI-SR patients

Discussion

Study:

The WAI-SR was considered at first as the best evaluation tool of therapeutic alliance in many domains: chronic pain ( 22), psychotherapy, and oncology.

Although medicine evolves (development of the telemedicine in certain country), the human link is still the essential factor of the therapeutic membership. The patients consider that it is the first treatment of their chronic disease [START_REF]Le médecin : le premier des médicaments essentiels. Plaidoyer pour la médecine clinique et la relation de soin[END_REF]. The studies also suggest that humble, rather than paternalistic, physicians are most effective at working with their patients [START_REF]The relationship between physician humility, physician-patient communication, and patient healthOriginal Research Article[END_REF].

However, the lack of teaching on the techniques of communication during the medical studies (25) as well as discrepancy between the opinions of patients and physicians [START_REF]Agreement in patient-physician communication in primary care: a study from Central and Eastern Europe[END_REF] slow down the implementation of a relationship of trust. In addition, each physician has its own psychological characteristics and good communication helps to alleviate the anxiety generated by the situations of uncertainty encountered frequently in medicine: cancer… [START_REF]Predictors of physicians' satisfaction with their management of uncertainty during a decision-making encounter with a simulated advanced stage cancer patient[END_REF].

Limits of the study:

Selection bias:

Experts characteristics showed that they were representatives of the desired population. Actually, there was more female than male. The physicians practiced mainly in urban zones. The experts were probably selected among the friendly network of the local investigator. They were interested by research and the characteristics' board showed that most of them had publications. Despite this, the selection bias was limited because experts spoke fluent English for the most part. This was the important point of the qualitative analysis.

Confusion and information bias:

There was neither confusion bias nor information bias, with application of a RAND/UCLA Appropriateness Method (28). Every expert was individually contacted without use of mailing list. They received same information.

Validity of the results:

The Delphi process was respected. This method limited the "leader opinion effect".

Each expert could express himself freely. Reproducibility was assured because each question of the WAI was validated more than seventy percent. Furthermore, twentysix doctors on thirty answered questionnaires. There was little of lost sight (no answers for three of them, too busy for one). The sample was established by twenty-six doctors who had a fluid English level. Nevertheless, the first results will have to be verify by a new study with a quantitative sample.

Perspectives:

Therapeutic alliance is an important concept for health sciences. This study achieved throughout in Europe will increase three main elements:

-In research: the translation of this scale in different language will permit to do studies. These studies will be based on the same evaluation tool. It will ensure the comparability of data between countries. These tasks will contribute to homogenize the practices in Europe.

- o the way that permits it to happen (Task).

Its use will establish a working support for the physician to increase its practice and its competences. The medicine is perpetual evolution. The physician must be able to questioning himself.

-In teaching: this tool will make students aware of quality of partnership between physician and patient. The training on communication will improve for the medicine students.

Conclusion

In this study, the Slovenian translation was carried out as close as possible to the English version by conciliating the subtleties of languages. The Slovenian translation of the WAI-SR will have a collective impact by improving knowledges on therapeutic alliance. It will facilitate the homogenization of practices between every country.

Therapeutic alliance is a recent concept associated with a desire to reduce the divide between physician and patient. Technological developments facilitate and improve daily medical practice, but the human link remains inherent to a quality therapeutic alliance.

It will also have an individual impact for every physician by facilitating the learning of communication during the studies, and the clinical practice. New hypotheses of searches can also be developed.

Annex

Annex 1: WAI-SR English version:

WAI-SR patients

Instructions: Below is a list of statements and questions about experiences people might have with their therapy or therapist. Some items refer directly to your therapist with an underlined space --as you read the sentences, mentally insert the name of your therapist in place of in the text. Think about your experience in therapy, and decide which category best describes your own experience.

IMPORTANT!!! Please take your time to consider each question carefully.

1. As a result of these sessions I am clearer as to how I might be able to change.

     

Seldom

Always

Very Often Fairly Often Sometimes Seldom 12. I believe the way we are working with my problem is correct.

     

Seldom

Sometimes Fairly

Often

Very Often Always

WAI SR Family Physician (English version)

Instructions: Below is a list of statements about experiences people might have with their client. Some items refer directly to your client with an underlined space -as you read the sentences, mentally insert the name of your client in place of in the text.

IMPORTANT!!! Please take your time to consider each question carefully. -Z ----------se strinjava -Z se strinjava o tem, kaj je zame pomembno, da počnem.

-Z zdravnikom se skupaj dogovarjava o tem, kaj je zame pomembno in na čem bi moral/a (več) delati.

-Z se strinjava o tem, kaj je zame pomembno, da počnem.

-Z----se strinjava o tem, kar je zame pomembno, da počnem -Z se strinjava/soglašava o tem, kaj je zame pomembno, da počnem.

-Z se strinjava glede tega, naj čem naj delam.

-Mogoče: …kaj bi bilo pomembno, da izboljšam.

-Z se strinjava glede tega, kaj je pomembno zame, da počnem.

-Z ------se strinjava o tem, kaj je zame pomembno, da počnem -Z se strinjava čemu se moram posvečati.

-Z se skupaj dogovarjava o dejavnostih, ki so zame pomembne.

-Z _ se strinjava glede pomembnih stvari, ki zahtevajo mojo pozornost (in delo/ trud).

66

-Z _ se dogovarjava katere stvari so zame pomembne, da jim namenim več svoje aktivnosti (/pozornosti) -Z _ se (skupaj) dogovarjava glede stvari, ki so zame pomembne in zahtevajo moj trud in delo.

Comments Q2 WAI-SR physician

-Skrbi me pacientovo dobro počutje.

-Morda Dobrobit namesto Blagostanje -Za blagostanje mi je resnično/dejansko mar.

-Resnično skrbim za blagostanje .

-Moja pristna skrb je dobro počutje ------------.

-Skrb za zdravje ------je moja osrednja skrb.

-Iskreno sem zaskerbljen(a) za dobrobit.

-Skrbi me za dobro počutje./Resnično me skrbi za dobro počutje.

-Blagostanje -PREDLOG Dobrobit -Resnično sem zaskrbljen za zdravnikovo dobro počutje.

-: Iskreno mi je mar za blagostanje.

-(morda: dobro zdravstveno stanje)

Comments Q10 WAI-SR physician :

-Z se strinjava, na čem mora delati. / Z se strinjava, kaj je zanj/zanjo pomembno predelati/izboljšati/početi.

-Z… se strinjava o tem, kakšni ukrepi so pomembni.

-Z se strinjava, kaj je zanj(o) pomembno, da počne.

-Z se skupaj dogovarjava o tem, kaj je zanj/o pomembno in na čem bi moral/a (več) delati.

-Z se strinjava, kaj je zanj(o) pomembno, da počne.

-Z… se strijava o tem, kaj je zanj/zanjo pomembno, da počne.

-Z----se strinjava, kaj je zanj(o) pomembno, da počne.

-Z se strinjava/soglašava, kaj je zanj(o) pomembno, da počne.

-Z se strinjava glede tega, na čemer naj dela.

-Z se strinjava, kaj je zanj pomembno, da izboljša.

-Strinjava se o tem, kaj je zanj/o pomembno, da počne.

-Strinjava se o tem, kaj je pomembno za ………, da počne. Strinjava se, kaj je za -------pomembno, da počne.

-Z se strinjava, kaj je zanj(o) pomembno, da počne.

-Z se skupaj strinjava, kaj je zanj(o) pomembno, da počne.

- Signature:

  In clinics: the definition of therapeutic alliance in WAI is based on the Bordin theory (1975). It brings together the points of view of Greenson, Orlinsky, Howard, Rogers and Freud (29). Their ideas concern psychotherapy. There are three mains headlines in this definition: o the link between patient and therapist (Bond) o their mutual agreement on therapeutics objectives (Goal)

  set the goals for my treatment.

I

  understood that the data collected during the research would be protected in accordance to confidentiality. They can only be accessed by persons subject to professional secrecy belonging to the team-investigating physician, mandated by the promoter. I accept the computerized processing of personal data in accordance with the data protection act. I have been informed of my right to access and rectify data concerning me. My consent does not absolve the responsibilities of the organizers of this research. I retain all my rights guaranteed by Law. Data for sampling: Birth date: Gender: Number of year in practice Practice type (solo, group, others) Setting type (rural (less than 2000 inhabitants), semi rural (between 2000 and 5000, urban (in English Number of publications in other languages English level : basic intermediate fluent (all publishers in English are fluent…) Done in two originals at……………, the dd/mm/yyyy Name, first name of investigator:Name, first name of the interviewee:

Table 1bis :

 1bis

	CODE	SETTING TYPE	TEACHING	RESEARCH	NUMBER PUBLICATION LEVEL ENGLISH	CONSENT
		RURAL	SEMI RURA URBAN	YES	NO	YES	NO	ENGLISH OTHER BASIC	INTERMED FLUENT

Table 2 :

 2

		WAI SR PATIENT		ROUND 1
	CODE	INSTRUCT IMPORT ANSWER	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11	Q12
	1	8

Table 4 :

 4 WAI SR PATIENT ROUND 2

	Expert	Q8
	1	7
	2	6
	3	8
	4	9
	5	9
	6	9
	7	5
	8	9
	9	8
	10	9
	11	9
	12	9
	13	9

  Prosimo, vzemite si čas in o vsakem vprašanju dobro razmislite Na vsako od 10 vprašanj WAI SR VPRAŠALNIKA ZA ZDRAVNIKE DRUŽINSKE MEDICINE je 5 možnih odgovorov, med katerimi lahko pacient izbira.

	Annex 4: Slovenian version after second Delphi round 4. Z skupaj postavljava cilje mojega zdravljenja.  5. cenim kot osebo.
	 11. Z INSTRUCTIONS:  WAI SR PATIENT:  sva razjasnila, katere spremembe bi mi koristile.         
	INSTRUCTIONS   5. Z     Navodila: spodaj je seznam trditev, povezanih z vašimi izkušnjami s pacienti. spoštujeva drug drugega.      Nekatere trditve se nanašajo neposredno na vašega pacienta in so v besedilu 6. Z sva razjasnila, katere spremembe bi bile zanj(o) koristne. Spodaj je seznam trditev in vprašanj o izkušnjah, ki jih lahko imajo ljudje s svojim zdravljenjem ali z zdravnikom družinske medicine. Nekatere trditve se nanašajo neposredno na vašega zdravnika družinske medicine in so v besedilu označene s podčrtanim praznim prostorom -ko berete stavek, v mislih vstavite ime vašega          označene s podčrtanim praznim prostorom -ko berete stavek, v mislih vstavite ime  vašega pacienta na mesto v tekstu.         12. Verjamem, da je način obravnave moje težave pravilen. 
	zdravnika na mesto zdravljenjem in se odločite, katera kategorija najbolje opiše vašo lastno izkušnjo. v tekstu. Pomislite na svoje izkušnje v zvezi z POMEMBNO !!! Prosimo,, vzemite si čas in o vsakem vprašanju dobro razmislite.      6. Z si prizadevava za cilje, ki sva jih skupaj določila.         7. Občutek imam, da me ceni.               7. Z spoštujeva drug drugega.         8. Z se strinjava glede njegovih/njenih ciljev.         POMEMBNO !!! 1.Z soglašava glede korakov, potrebnih za izboljšanje 9. spoštujem celo takrat, ko počne stvari, ki jih ne odobravam.  8. Z njegovega/njenega stanja.      se strinjava, kaj je zame pomembno, da izboljšam.    2. Obravnava pri mojem zdravniku(ci) mi omogoča nove poglede na težavo, s katero se spoprijemam.        9. Občutek imam, da je mar zame celo takrat, ko počnem stvari, 2. Dobrobit je moja osrednja skrb             10. Z se strinjava, kaj je zanj(o) pomembno, da izboljša.
	 ki jih ne odobrava. 	 	 	 	 
	 
	(Enako kot zgoraj)          3. Prizadevava si za dosego skupaj dogovorjenih ciljev.     3. Zdi se mi, da sem všeč.             10. Občutek imam, da mi bo to, kar počnem v sklopu obravnave/zdravljenja,     pomagalo doseči želene spremembe. 4. Oba z zaupava v koristnost najinih trenutnih dejavnosti v obravnavi
	 	 	 	 	 

TRANSLATION  redko  včasih  kar pogosto  zelo pogosto  vedno 1. Zaradi posvetov pri zdravniku mi je bolj jasno, kako bi se lahko spremenil(a). TRANSLATION  redko  včasih  kar pogosto  zelo pogosto  vedno

Remerciements

Rarely Sometimes

Fairly Often

Very Often Always

Local investigator name

Address: ……………………………………..

University:

Asked me to participate in a forward backward translation study I had time to reflect on my involvement in this study. I am aware that my participation is completely voluntary and that the study will entail no additional cost to my charge.

I can, at any time, decide to leave the study without giving reasons for my decision and that it does without consequences.

Consent Form

And Data for sampling Promoter : Département Universitaire de Médecine Générale -22 avenue Camille Desmoulins -29238 Brest Cedex 3

RIOU (Marine) -Translation of the WAI-SR in Slovenian, according to a forward-backward translation and a Delphi consensus procedure.

Abstract:

Introduction: Therapeutic alliance (TA) is a fundamental concept based on communication skills. It is defined a quality as the relationship between physician and patient with the objective to enhance observance. It is of importance for the follow up of chronic diseases. The lack of European data on the subject promoved this study. A systematic literature review and a RAND/UCLA Appropriateness Method identified the Working Alliance Inventory Short Revised (WAI-SR) as the most appropriate scale to evaluate the TA (according to its reproducibility and reliability). The purpose of this study was to achieve the translation of the WAI-SR in Slovenian, according to a forwardbackward translation and a Delphi consensus procedure.

Method: A research group composed of therapists and bilingual experts produced a forward translation. Slovenian general practitioners (GPs) validated it using a Delphi procedure. After obtaining a consensus, two independent translators worked together to carry out a backward translation. They had especially to take care of linguistic differences.

Result: Twenty-six GPs participated. The Slovenian version of the WAI was validated after two Delphi rounds. The backward translation was achieved by two professional linguists. The differences noted, linked to linguistic variations did not bring any change of semantics regarding the original version.

Conclusion: Translation of the WAI-SR into Slovenian using a reliable and reproducible method, will have a triple interest. It will permit homogenization of medical European practices. Its use will establish a working support for the physician to increase its practice and its competences. And finally, communication training for medical students could be improved.