IMPROVING PHYSICIANS INTERVIEWING SKILLS AND REDUCING PATIENTS EMOTIONAL DISTRESS - A RANDOMIZED CLINICAL-TRIAL
IMPROVING PHYSICIANS INTERVIEWING SKILLS AND REDUCING PATIENTS EMOTIONAL DISTRESS - A RANDOMIZED CLINICAL-TRIAL
复制标题
DOI：
10.1001/archinte.155.17.1877
复制
发表时间：
1995-09-25
影响因子：
--
通讯作者：
ROCA, RP
中科院分区：
文献类型：
--
作者：
ROTER, DL;HALL, JA;ROCA, RP
背景资料：尽管患病率高，初级保健患者的情绪困扰往往在日常医疗encounters.Objective：探讨沟通技巧培训的过程和结果的护理与患者的情绪困扰的影响：方法：一个随机，对照现场试验进行了69初级保健医生和648他们的病人。医生被随机分配到一个没有培训的对照组或两个旨在帮助医生解决患者情绪困扰的沟通技巧培训课程之一。这两个培训班通过确定问题的技能或处理情绪的技能来解决沟通问题。所有的研究医生的办公室访问进行录音，直到五个情绪困扰和五个nondistressed患者入组的基础上，患者的一般健康问卷的反应。医生们也被录音采访一个模拟病人，以评估临床熟练程度。电话监测的痛苦的病人利用医疗服务和一般健康问卷评分进行了2周，3个月，6个月后，他们的录音办公室visits.Results：录音带分析的实际和模拟的病人表明，受过训练的医生使用的问题定义和情绪处理技能比未经培训的医生，没有增加的访问长度。经过培训的医生也报告了更多的心理问题，参与了更多的策略来管理实际患者的情绪问题，并在模拟患者的临床熟练度方面得分更高。接受过培训的医生的患者报告称，情绪困扰在长达6个月的时间里得到了减轻。结论：经过8小时的课程后，医生的沟通技巧发生了明显的重要变化。培训改善了护理过程和结果，而没有延长探视时间。
Background: Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters.Objective: To explore the effect of communication-skills training on the process and outcome of care associated with patients' emotional distress.Methods: A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients' emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits.Results: Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months.Conclusions: Important changes in physicians' communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.