How stressful is doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations
How stressful is doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations
复制标题
DOI：
10.1016/j.ijpsycho.2010.04.001
复制
发表时间：
2010-07-01
影响因子：
3
通讯作者：
Smets, Ellen M. A.
中科院分区：
文献类型：
--
作者：
Hulsman, Robert L.;Pranger, Susan;Smets, Ellen M. A.
引言：医疗沟通对医生和患者来说都是一种紧张的经历。特别是，缺乏经验的医生面临着一个坏消息咨询的艰巨任务，可能会遇到高水平的痛苦。本探索性研究的目的是测试学生的差异心血管反应的历史采取和坏消息咨询与模拟病人，并测试学生的自我报告的压力咨询和他们的心血管反应之间的关系：方法：第四和第五年的医学生（n = 20）进行了病史（HT）和一个坏消息（BN）咨询，在一个标准化的病人随机顺序。心率（HR），平均动脉压（MAP），心输出量（CO）和全身血管阻力（SVR）通过Finapres技术在四种情况下进行评估：休息，阅读，并在两个咨询。自我报告的压力进行了评估之前和之后，每次采访使用状态和特质焦虑量表（STAI），和视觉模拟量表（VAS）。结果：HT和BN引起更多的心血管压力比阅读。与所有其他条件相比，坏消息引起了最高的HR和CO反应，并且在学生第一次咨询时产生了更大的影响。STAI和VAS数据显示了与心血管应激措施的一些相关性，并且在应激response.Discussion中具有可比性但不太显著的模式：HT和BN咨询对学生压力水平的顺序的影响表明了新奇和习惯性的额外影响。对病人的不熟悉可能会增加宣布坏消息的压力。(C)2010爱思唯尔有限公司版权所有。
Introduction: Medical communication can be a stressful experience for both doctors and patients. In particular, inexperienced doctors facing the demanding task of a bad news consultation may experience high levels of distress. The aim of this exploratory study is to test students' differential cardiovascular reactivity to history taking and bad news consultations with a simulated patient, and to test the relation between the students' self-reported stressfulness of the consultation and their cardiovascular response:Methods: Fourth and fifth year medical students (n = 20) conducted a history taking (HT) and a bad news (BN) consultation in a randomized order with a standardized patient. Heart rate (HR), mean arterial pressure (MAP), cardiac output (CO) and systemic vascular resistance (SVR) were assessed by way of the Finapres-technique in four conditions: rest, reading aloud, and during both consultations. Self-reported stress was assessed before and after each interview using the State and Trait Anxiety Inventory (STAI), and a visual analogue scale (VAS).Results: Both HT and BN provoked more cardiovascular stress than reading. Bad-news provoked the highest HR and CO responses compared to all other conditions, and had a greater impact when it was the student's first consultation. The STAI and VAS data showed some correlations with the cardiovascular stress measures and a comparable but less significant pattern in stress response.Discussion: The effect of order of the HT and BN consultations on the students' stress levels suggests an additional impact of novelty and habituation. Unfamiliarity with the patient may enhance the stressfulness of the task of breaking bad news. (C) 2010 Elsevier B.V. All rights reserved.