Physician-patient interactions and communication with conscious patients during simulated cath lab procedures: an exploratory study.
Physician-patient interactions and communication with conscious patients during simulated cath lab procedures: an exploratory study.
复制标题
在模拟导管实验室手术过程中，医患互动以及与意识清醒的患者的沟通：一项探索性研究。
DOI：
10.1136/bmjstel-2017-000249
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发表时间：
2019
影响因子：
1.1
通讯作者：
Kelay T
中科院分区：
文献类型：
--
作者：
Kelay T
背景本探索性研究探讨了使用模拟技术观察和评估术中沟通实践的可行性。复杂的手术越来越多地在病人完全清醒的情况下对病人进行局部麻醉。介入心脏手术就是这样一个例子，其中患者报告了接受手术的高水平焦虑。虽然沟通方式可以缓解患者在干预过程中的焦虑，从而获得更好的患者体验，但很少有关于沟通的观察性研究，而术中患者的观点则未得到充分探索。方法在这项混合方法研究中，对20个视频记录的模拟场景进行了观察分析，其中包括医生操作员（不同经验水平），在受控和高度逼真的导管实验室环境中与模拟患者（经过培训的演员）进行沟通和互动。两个独立的评分员和模拟的病人嵌入在场景回顾性地评价医生的沟通方式和互动与病人通过四个关键参数。通过焦虑的定量测量和半结构化定性访谈，进一步探讨了患者的沟通观点。结果虽然独立评级的医患沟通表现出一些明显的差异，根据医生的经验水平，病人的评级一直较高的经验丰富的医生和新手医生的四种互动风格。此外，患者的焦虑评分根据操作者的经验水平是可区分的。主题分析提供了进一步的见解，病人的观点，包括情感维度的特点，以及医生的互动如何可以放大或减弱焦虑的感觉，通过语调，在程序中的沟通连续性，沟通，同时多任务处理和与病人的连接。结论：我们的研究结果表明，潜在的病人假设医生的经验水平，术中沟通方式和焦虑的影响。虽然观察方法可以应用于模拟术中临床环境，但评价技术（如观察评级工具）需要纳入患者对接受有意识手术的看法。
Background This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored. Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews. Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the procedure, communicating while multitasking and connecting with the patient. Conclusions Our findings indicate underlying patient assumptions about physicians’ experience levels, intraoperative communication styles and impact on anxiety. While observational methods can be applied to simulated intraoperative clinical contexts, evaluation techniques such as observational rating tools need to incorporate patient perspectives about undergoing conscious surgery.