Health-related quality-of-life assessments and patient-physician communication - A randomized controlled trial
Health-related quality-of-life assessments and patient-physician communication - A randomized controlled trial
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DOI：
10.1001/jama.288.23.3027
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发表时间：
2002-12-18
影响因子：
120.7
通讯作者：
Aaronson, NK
中科院分区：
文献类型：
--
作者：
Detmar, SB;Muller, MJ;Aaronson, NK
人们对在日常临床实践中使用与健康有关的生活质量（HRQL）评估越来越感兴趣，但很少有实证研究来评估这种评估的有用性。目的评价标准化HRQL评估在促进医患沟通、提高医生对患者HRQL相关问题认识方面的效果。前瞻性、随机交叉试验。背景：荷兰某癌症医院门诊。在1996年6月11日至1998年6月期间，10名医生和214名接受姑息性化疗的患者（76%为女性，平均年龄57岁）被邀请参加。在连续3次门诊就诊时，患者完成HRQL问卷（欧洲癌症研究和治疗组织生活质量问卷-核心30）。计算机对这些回答进行评分，并将其转换为图形摘要。医生和病人在会诊前都会收到一份摘要副本。主要观察指标对会诊录音进行内容分析，评价医患沟通。通过比较医生和患者在达特茅斯初级保健合作信息功能健康评估（COOP）和世界组织国家学院和学术项目（WONCA）图表上的评分，来评估医生对患者健康问题的认识。结果干预组讨论H rql相关问题的频率明显高于对照组（平均[SDI交流综合评分：4.5 [2.3]vs 3.7[1.9]），差异有统计学意义（P= 0.01）。干预组的医生在几个HRQL领域中发现了比对照组更高比例的中度至重度健康问题患者。所有的医生和87%的患者认为干预促进了沟通，并表示有兴趣继续使用。结论在日常临床肿瘤学实践中纳入标准化的HRQL评估有助于对HRQL问题的讨论，提高医生对患者HRQL的认识。
Context There has been increasing interest in the use of health-related quality-of-life (HRQL) assessments in daily clinical practice, yet few empirical studies have been conducted to evaluate the usefulness of such assessments.Objective To evaluate the efficacy of standardized HRQL assessments in facilitating patient-physician communication and increasing physicians' awareness of their patients' HRQL-related problems.Design Prospective, randomized crossover trial. Setting Outpatient clinic of a cancer hospital in the Netherlands. Participants Ten Physicians and 214 patients (76% women; mean age, 57 years) undergoing palliative chemotherapy who were invited to participate between June 11 996 and June 1998.Intervention At 3 successive outpatient visits, patients completed an HRQL questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). The responses were computer scored and transformed into a graphic summary. Physicians and patients received a copy of the summary before the consultation.Main Outcome Measures Audiotapes of the consultations were content analyzed to evaluate patient-physician communication. Physicians' awareness of their patients' health problems was assessed by comparing physicians' and patients' ratings on the Dartmouth Primary Care Cooperative Information Functional Health Assessment (COOP) and the World Organisation Project of National Colleges and Academics (WONCA) charts.Results The H RQL-related issues were discussed significantly more frequently in the intervention than in the control group (mean [SDI communication composite scores: 4.5 [2.3] vs 3.7 [1.9], respectively (P=.01). Physicians in the intervention group identified a greater percentage of patients with moderate-to-severe health problems in several HRQL domains than did those in the control group. All physicians and 87% of the patients believed that the intervention facilitated communication and expressed interest in its continued use.Conclusion Incorporating standardized HRQL assessments in daily clinical oncology practice facilitates the discussion of HRQL issues and can heighten physicians' awareness of their patients' HRQL.