Hagihara Akihito, Tarumi Kimio
Department of Health Services Management and Policy, Graduate School of Medicine, Kyushu University, Higashi-ku, Fukuoka, Japan.
Scand J Caring Sci. 2006 Jun;20(2):143-50. doi: 10.1111/j.1471-6712.2006.00420.x.
Several measures, such as the frequency, duration and ratio of quantitative communication behaviours, have been used to evaluate patient-doctor communication; however, these measures have several major problems. Therefore, we examined whether doctors' and patients' perceptions of the level of doctors' explanations provide a better measure for evaluating the quality of patient-doctor communication.
The subjects were 630 doctor-patient pairs in Japan. One-way anova and multiple logistic regression analysis were used for the data analysis.
Of 190 doctors and 950 patients selected randomly, 126 doctors and 630 patients returned questionnaires (response rates, both 66.3%). We found the following. (i) With respect to the sufficiency of the doctor explanation, the 'patient-better' situation (i.e. when patients' evaluations were better than doctors' evaluations) had a more positive influence on patients' outcome measures than did other situations. (ii) The 'doctor better' situation (i.e. when doctors' evaluations were better than patients' evaluations) had the most negative influence on patient outcome measures compared with the other situations. (iii) The length of clinical experience, patient gender and guidance concerning a change in lifestyle were predictors of the doctor-better condition in the two types of doctor explanations.
A measure that classifies patient-doctor pairs into doctor-better and the other situations might be effective for evaluating the quality of patient-doctor communication. As this is a new approach to evaluating patient-doctor communication, more studies are necessary to verify these findings.
诸如定量沟通行为的频率、时长和比例等多项指标已被用于评估医患沟通;然而,这些指标存在若干重大问题。因此,我们考察了医生和患者对医生解释水平的认知是否能为评估医患沟通质量提供更好的指标。
研究对象为日本的630对医患。数据分析采用单因素方差分析和多元逻辑回归分析。
在随机选取的190名医生和950名患者中,126名医生和630名患者返还了问卷(回复率均为66.3%)。我们发现以下情况。(i)就医生解释的充分性而言,“患者评价更高”的情况(即患者评价优于医生评价时)对患者的结果指标产生的积极影响大于其他情况。(ii)与其他情况相比,“医生评价更高”的情况(即医生评价优于患者评价时)对患者结果指标的负面影响最大。(iii)临床经验时长、患者性别以及生活方式改变方面的指导是两种类型医生解释中“医生评价更高”情况的预测因素。
将医患对分为“医生评价更高”和其他情况的指标可能对评估医患沟通质量有效。由于这是评估医患沟通的一种新方法,需要更多研究来验证这些发现。