Schouten Barbara C, Meeuwesen Ludwien, Harmsen Hans A M
Interdisciplinary Social Science Department, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands.
Patient Educ Couns. 2005 Sep;58(3):288-95. doi: 10.1016/j.pec.2005.06.005.
Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor-patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor-patient communication.
Participants (general practitioners: n=38; patients: n=124) were assigned at random to an intervention or a control group. GPs in the intervention group received 2.5 days training on intercultural communication. Patients in the intervention group were exposed to a videotaped instruction in the waiting room, right before the consultation. Data were collected through videotapes of visits of ethnic minority patients to their GP and home interviews with the patients after their medical visit. Communication behaviour was assessed using the Roter interaction analysis system (RIAS). Interview length was assessed as well.
The length of the medical encounter increased significantly after having received the intervention. Total number of GP utterances increased significantly too. When comparing relative frequencies on affective and instrumental verbal behaviour of both patients and doctors, no significant changes could be detected.
It is concluded that there seems to be some change in doctor-patient interaction, but RIAS may not be suitable to detect subtle changes in the medical communication process. It is recommended to use other analysis methods to assess cultural differences in medical communication.
Knowledge about possible antecedents of gaps in intercultural medical communication should be increased in order to be able to design effective interventions for intercultural doctor-patient communication.
现有为数不多的研究结果表明，跨文化医患沟通存在重大差距。为改善荷兰医疗实践中的跨文化沟通，开发了一种教育干预措施。本研究的目的是检验这种干预措施对医患沟通的效果。
参与者（全科医生：n = 38；患者：n = 124）被随机分配到干预组或对照组。干预组的全科医生接受了2.5天的跨文化沟通培训。干预组的患者在会诊前，于候诊室观看了录像指导。数据通过少数族裔患者拜访全科医生的录像以及患者就诊后在家中接受访谈收集。使用罗特互动分析系统（RIAS）评估沟通行为。还评估了访谈时长。
接受干预后，医疗问诊时长显著增加。全科医生的话语总数也显著增加。比较患者和医生在情感和工具性言语行为上的相对频率时，未发现显著变化。
得出的结论是，医患互动似乎有一些变化，但RIAS可能不适用于检测医疗沟通过程中的细微变化。建议使用其他分析方法来评估医疗沟通中的文化差异。
应增加对跨文化医疗沟通差距可能的前因的了解，以便能够设计有效的跨文化医患沟通干预措施。
