Teaching senior oncologists communication skills: Results from phase I of a comprehensive longitudinal program in the United Kingdom
Teaching senior oncologists communication skills: Results from phase I of a comprehensive longitudinal program in the United Kingdom
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DOI：
10.1200/jco.1998.16.5.1961
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发表时间：
1998-05-01
影响因子：
45.3
通讯作者：
Hall, A
中科院分区：
文献类型：
--
作者：
Fallowfield, L;Lipkin, M;Hall, A
目的：了解临床医生在肿瘤医学中遇到的沟通困难，并制定、实施和评估沟通技巧培训课程。方法：178名高级临床医生参加了为期1天半或3天的住院课程，旨在提高技能发展，知识获取和个人意识。课程内容包括结构化反馈、访谈视频回顾、互动小组演示以及由训练有素的辅导员领导的四人小组讨论。主要的结果是在沟通的关键方面自我评估的信心，态度转向更以病人为中心的访谈，个人实践的感知变化，以及对初级员工的教学计划的启动。结果：不到35%的参与者之前接受过任何沟通培训。时间、经验和资历并没有提高技能；在课程开始之前，肿瘤学家表达了998种不同的沟通困难，主要的问题是提供复杂的信息，获得知情同意，以及处理种族和文化差异。关键沟通领域的信心评分在治疗后显著提高（P < 0.01）。课程结束三个月后，95%的医生报告他们的医学实践发生了重大变化。75%的人在初级临床医生沟通方面开展了新的教学活动。临床医生对患者心理社会需求的态度发生了积极的转变（P = 0.0002），并且更加以患者为中心（P = 0.03）。这些课程评价很高，97%的人“肯定”会推荐给同事。结论：肿瘤医生的沟通技巧培训不足，会放弃时间来纠正这一点。术后立即报告的主观改善维持在3个月。需要教育活动的资源来帮助患者和他们的医生。
Purpose: To determine the communication difficulties experienced by clinicians in cancer medicine and to develop, implement, and evaluate communication skills training courses.Methods: One hundred seventy-eight senior clinicians attended 1 1/2- or 3-day residential courses designed to enhance skills development, knowledge acquisition, and personal awareness. Course content included structured feedback, video review of interviews, interactive group demonstrations, and discussion in groups of four led by trained facilitators. The main outcomes were self-rated confidence in key aspects of communication, attitudinal shift toward more patient-centered interviewing, perceived changes in personal practice, and initiation of teaching programs for junior staff.Results: Less than 35% of the participants had received any previous communications training. Time, experience, and seniority had not improved skills; before the course, oncologists expressed difficulty with 998 different communication issues, Primary problems concerned giving complex information, obtaining informed consent, and handling ethnic and cultural differences. Confidence ratings far key communication areas were significantly improved postcourse (P < .01). three months postcourse, 95% of the physicians reported significant changes in their practice of medicine. Seventy-five percent had starred new teaching initiatives in communication for junior clinicians. Clinicians showed positive shifts in attitude coward patients' psychosocial needs (P = .0002) and were more patient centered (P = .03). The courses were highly rated and 97% would "definitely" recommend them to colleagues.Conclusion: Oncologists are hampered by inadequate communication skills training and will give up time to correct this. Subjective improvements reported immediately postcourse were maintained at 3 months. Resources for educational initiatives are needed to help both patients and their physicians.