Dowsett S M, Saul J L, Butow P N, Dunn S M, Boyer M J, Findlow R, Dunsmore J
Medical Psychology Unit, Department of Medicine, University of Sydney, Sydney, Australia.
Psychooncology. 2000 Mar-Apr;9(2):147-56. doi: 10.1002/(sici)1099-1611(200003/04)9:2<147::aid-pon443>3.0.co;2-x.
Although doctor-patient communication has been the focus of numerous studies, there is a lack of empirical evidence on which to base a curriculum for teaching effective communication skills for use in an oncology setting. Research within the general practice area identifies patient-centred and doctor-centred behaviours as the most important dimensions of doctor-patient communication. This study examined patients and their relatives/friends' preferences for and satisfaction with patient-centred and doctor-centred consulting styles. It was argued that by determining patient preferences for consulting styles, specific recommendations for improving communication in the oncology setting could be formulated.
One hundred and thirteen women who had been treated for breast cancer and 48 of their relatives or friends watched videotaped scenarios of an oncology consultation, using professional actors. Viewers were randomly allocated to either a good prognosis or poor prognosis video, in which the oncologist discussed the patient's diagnosis, treatment and prognosis. These segments were presented in both styles to allow viewers to directly compare and contrast the patient-centred and doctor-centred approach. Outcomes included style preference and satisfaction. Demographic details, information and involvement preferences, anxiety and depression levels were also obtained.
Both patients and their relatives or friends significantly preferred a patient-centred consulting style across all aspects of the consultation (p<0.0001), except within the treatment segment of the good prognosis video where there was no significant difference. One third of the viewers preferred a doctor-centred style for the treatment and prognosis segments. Predictors of a patient-centred style preference in the treatment and prognosis segments included watching a poor prognosis video (OR=2.45, 95% CI 1.04-5.81, p=0.04; OR=3.22, 95% CI 1.22-8.50, p=0.02, respectively), and being employed in a professional occupation (OR=2.38, 95% CI 1.02-5.53, p=0.04 for the treatment segment only). Satisfaction ratings varied within and across videos.
Despite some methodological limitations, this study provides empirical data indicating that patients and their relatives or friends prefer a patient-centred approach to the consultation, particularly when the patient has a poor prognosis. The fact that a substantial minority of patients preferred a doctor-centred style emphasizes the need to enhance physicians' abilities to recognize different patient needs throughout the consultation.
尽管医患沟通一直是众多研究的焦点，但缺乏实证依据来为肿瘤学环境中有效沟通技能的教学课程提供基础。全科医疗领域的研究将以患者为中心和以医生为中心的行为确定为医患沟通的最重要维度。本研究调查了患者及其亲属/朋友对以患者为中心和以医生为中心的咨询方式的偏好及满意度。有人认为，通过确定患者对咨询方式的偏好，可以制定出改善肿瘤学环境中沟通的具体建议。
113名接受过乳腺癌治疗的女性及其48名亲属或朋友观看了由专业演员出演的肿瘤学咨询录像场景。观看者被随机分配到预后良好或预后不良的视频组，视频中肿瘤学家讨论了患者的诊断、治疗和预后。这些片段以两种方式呈现，以便观看者直接比较和对比以患者为中心和以医生为中心的方法。结果包括方式偏好和满意度。还获取了人口统计学细节、信息和参与偏好、焦虑和抑郁水平。
除了在预后良好视频的治疗部分没有显著差异外，患者及其亲属或朋友在咨询的各个方面都显著更喜欢以患者为中心的咨询方式（p<0.0001）。三分之一的观看者在治疗和预后部分更喜欢以医生为中心的方式。在治疗和预后部分，以患者为中心的方式偏好的预测因素包括观看预后不良的视频（治疗部分的OR=2.45，95%CI 1.04-5.81，p=0.04；预后部分的OR=3.22，95%CI 1.22-8.50，p=0.02），以及从事专业职业（仅治疗部分的OR=2.38，95%CI 1.02-5.53，p=0.04）。不同视频内部和之间的满意度评分有所不同。
尽管存在一些方法学上的局限性，但本研究提供了实证数据，表明患者及其亲属或朋友更喜欢以患者为中心的咨询方式，尤其是当患者预后不良时。相当一部分患者更喜欢以医生为中心的方式这一事实强调了提高医生在整个咨询过程中识别不同患者需求能力的必要性。
