Patient-physician communication during outpatient palliative treatment visits - An observational study
Patient-physician communication during outpatient palliative treatment visits - An observational study
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DOI：
10.1001/jama.285.10.1351
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发表时间：
2001-03-14
影响因子：
120.7
通讯作者：
Aaronson, NK
中科院分区：
文献类型：
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作者：
Detmar, SB;Muller, MJ;Aaronson, NK
背景改善健康相关的生活质量(HRQL)是姑息治疗的一个重要目标，但人们对姑息治疗期间关于HRQL主题的实际医患沟通知之甚少。目的调查肿瘤学家和他们的患者之间关于四个特定HRQL问题的常规沟通的内容，并确定与这些问题的讨论显著相关的患者、医生和来访的特定因素。设计观察研究于1996年11月至1998年1月进行，设置荷兰一家癌症医院的门诊姑息化疗诊所，参与者10名肿瘤学家和240名患者(72%为女性；主要结果采用Roter互动分析系统对门诊就诊期间患者和医生的问卷调查和日常活动、情绪功能、疼痛和疲劳等沟通情况进行了录音分析。结果的谈话中有23%是关于医疗/技术问题，23%是关于人力资源生活质量的问题。患者的沟通行为在医疗/技术问题(41%)和HRQL主题(48%)之间分配得更平均。在被调查的自变量中，患者自我报告的HRQL是讨论HRQL问题的最有力的预测因子。然而，在患者经历严重的HRQL问题的会诊中，有20%至54%的患者没有时间讨论这些问题。特别是，这些患者的情绪功能和疲劳分别有54%和48%的时间没有得到解决。在评估肿瘤反应的会诊中，对HRQL问题的讨论并不频繁。结论尽管越来越多的人认识到维持患者的HRQL作为姑息治疗目标的重要性，但投入到此类问题上的医患沟通量仍然有限，至少在日常临床实践中，似乎对评估治疗效果的贡献不大。
Context Improving health-related quality of life (HRQL) is an important goal of palliative treatment, but little is known about actual patient-physician communication regarding HRQL topics during palliative treatment.Objectives To investigate the content of routine communication regarding 4 specific HRQL issues between oncologists and their patients and to identify patient-, physician-, and visit-specific factors significantly associated with discussion of such issues.Design Observational study conducted between lune 1996 and January 1998,Setting Outpatient palliative chemotherapy clinic of a cancer hospital in the Netherlands,Participants Ten oncologists and 240 of their patients (72% female; mean age, 55 years) who had incurable cancer and were receiving outpatient palliative chemotherapy.Main outcome Measures Patient and physician questionnaires and audiotape analysis of communication regarding daily activities, emotional functioning, pain, and fatigue during an outpatient consultation using the Roter Interaction Analysis System.Results Physicians devoted 64% of their conversation to medical/technical issues and 23% to HRQL issues. Patients' communication behavior was divided more equally between medical/technical issues (41%) and HRQL topics (48%). Of the independent variables investigated, patients' self-reported HRQL was the most powerful predictor of discussing HRQL issues. Nevertheless, in 20% to 54% of the consultations in which patients were experiencing serious HRQL problems, no time was devoted to discussion of those problems. In particular, these patients' emotional functioning and fatigue were unaddressed 54% and 48% of the time, respectively. Discussion of HRQL issues was not more frequent in consultations in which tumor response was evaluated.Conclusion Despite increasing recognition of the importance of maintaining patients' HRQL as a goal of palliative treatment, the amount of patient-physician communication devoted to such issues remains limited and appears to make only a modest contribution, at least in an explicit sense, to the evaluation of treatment efficacy in daily clinical practice.