Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors
Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors
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DOI：
10.1016/j.pec.2006.06.011
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发表时间：
2006-09-01
影响因子：
3.5
通讯作者：
Gordon, Nahida H.
中科院分区：
文献类型：
--
作者：
Siminoff, Laura A.;Graham, Gregory C.;Gordon, Nahida H.
目的：探讨肿瘤医师与乳腺癌患者之间的沟通模式是否与患者特征相关。方法：对14个诊所的58名肿瘤学家和405名新诊断的无乳腺癌病史的患者进行研究。对肿瘤医生和患者的初次会诊进行录音，并进行详细的交流分析。在会诊前后立即与患者和医生进行了访谈。结果：在所有患者人口统计数据中发现了差异。年轻的病人问了更多的问题，那些白人有高中以上的教育程度，当他们报告的收入是高或中等收入时，与低收入相比（p < 0.01）。患者的主动行为，如主动向医生提供信息，与所有人口统计学预测指标相似，医生倾向于向患者提问。尽管这次会面具有内在的情感性质，但令人惊讶的是，很少有人公开讨论病人对她的诊断的感受以及她如何应对。病人和医生都花时间试图建立彼此之间的人际关系，尽管病人花的时间更多。不同年龄、受教育程度和收入的患者在关系建立话语数量上存在差异，医生与白人建立关系的时间比非白人患者多（p < 0.01），受教育程度和富裕程度的患者多（p < 0.05）。结论：本研究表明，患者人口统计学因素，如种族、收入水平、教育程度和年龄，似乎影响了医生花费在几乎所有患者沟通类别上的时间。在大多数交流类别中，一个反复出现的差异是种族。种族差异几乎出现在每一种被调查的交流类别中。白人患者在几乎所有交流类别中都比非白人患者有更多的话语。这些差异可能意味着，对于种族或少数民族、较不富裕、年龄较大和受教育程度较低的患者来说，决策过程不太充分。实践启示：本研究发现，提供者与患者的沟通因年龄、种族、教育程度和收入的不同而不同。这些沟通上的差异可能导致患者预后的差异。沟通技巧培训应明确训练临床医生认识到这些倾向。具有不同人口统计特征的患者也可能需要为他们量身定制的教育。2006爱思唯尔爱尔兰有限公司版权所有。
Objective: To examine whether patient characteristics are associated with communication patterns between oncologists and breast cancer patients.Methods: The study was conducted at 14 practices with 58 oncologists with 405 newly diagnosed patients with no prior history of breast cancer. The initial consultation between oncologist and patient was audiotaped and a detailed communication analysis performed. Interviews were conducted with patients and physicians immediately before and after consultations.Results: Disparities were found across all patient demographics. Younger patients asked more questions as did those who were white had more than a high school education and when they reported an income that was high or medium income, compared to low (p < 0.01). Patient proactive behavior, such as volunteering information to the physician unasked, was similarly related with all demographic predictors as was physician tendency to ask patients questions. Despite the inherently emotional nature of this encounter, there was surprisingly little overt discussion about how the patient felt about her diagnosis and how she was coping. Both patients and physicians spent time trying to establish an interpersonal relationship with each other, although patients spent more time. Patients differed in the number of relationship building utterances by age, education and income and physicians spent more time engaged in relationship building with white than non-white patients (p < 0.01) and more educated and affluent patients (p < 0.05).Conclusion: This study indicates that patient demographic factors, such as race, income level, education and age seem to influence the amount of time physicians spend in almost all communication categories with patients. One recurring difference across most communication categories was race. Racial differences occurred in almost every one of the communication categories examined. White patients had many more utterances in almost every communication category than their non-white counterparts. These differences may mean a less adequate decision-making process for patients who are members of racial or ethnic minorities, patients who are less affluent, older, and have less education.Practice implications: This study found that providers communicate differently with patients by age, race, education and income. These differences in communication may lead to disparities in patient outcomes. Communication skills training should explicitly train clinicians to recognize these tendencies. Patients with different demographics characteristics may also required education that is tailored to them. (c) 2006 Elsevier Ireland Ltd. All rights reserved.