改善医生与乳腺癌患者之间的沟通。
Improving communication between doctors and breast cancer patients.
作者信息
Stewart Moira, Brown Judith Belle, Hammerton Joanne, Donner Allan, Gavin Alan, Holliday Ronald L, Whelan Tim, Leslie Ken, Cohen Irene, Weston Wayne, Freeman Tom
机构信息
Centre for Studies in Family Medicine, The University of Western Ontario, London, Ontario, Canada.
出版信息
Ann Fam Med. 2007 Sep-Oct;5(5):387-94. doi: 10.1370/afm.721.
PURPOSE
We wanted to assess the effectiveness of intensive education for physicians compared with a traditional session on communicating with breast cancer patients.
METHODS
A randomized controlled trial was conducted in practices in London, Hamilton, and Toronto, Canada, with 17 family physicians, 16 surgeons, and 18 oncologists, and with 102 patients of the surgeons and oncologists. Doctors were randomized to 1 of 2 continuing education approaches: a traditional 2-hour version (control group), or a new 6-hour intensive version including exploring the patients' perspectives and reviewing videotapes and receiving feedback (intervention group). Communication behavior of the physicians was measured objectively both before and after the intervention. As well, 4 postintervention patient outcomes were measured, by design only for surgeons and oncologists: patient-centerdness of the visit, satisfaction, psychological distress, and feeling better.
RESULTS
No significant differences were found on the communication score of the intervention vs the control physicians when controlling for preintervention communication scores. Intervention family physicians, however, had significantly higher communication subscores than control family physicians. Also, patients of the intervention surgeons and oncologists were significantly more satisfied (scores of 82.06 vs 77.78, P = .03) and felt better (88.2% vs 70.6%, P=.02) than patients of the control surgeons and oncologists when controlling for covariates and adjusting for clustering within doctor.
CONCLUSIONS
The continuing medical education intervention was effective in terms of some but not all physician and patient outcomes.
目的
我们希望评估与传统的乳腺癌患者沟通课程相比，针对医生的强化教育的效果。
方法
在加拿大伦敦、汉密尔顿和多伦多的医疗机构中进行了一项随机对照试验，涉及17名家庭医生、16名外科医生和18名肿瘤学家，以及102名外科医生和肿瘤学家的患者。医生被随机分配到两种继续教育方式中的一种：传统的2小时课程（对照组），或新的6小时强化课程，包括探索患者的观点、观看录像带并接受反馈（干预组）。在干预前后客观地测量医生的沟通行为。此外，测量了4项干预后的患者结果，仅针对外科医生和肿瘤学家设计：就诊的以患者为中心程度、满意度、心理困扰和感觉好转情况。
结果
在控制干预前的沟通分数时，干预组医生与对照组医生的沟通得分没有显著差异。然而，干预组的家庭医生的沟通子得分显著高于对照组的家庭医生。此外，在控制协变量并调整医生内部的聚类情况后，干预组外科医生和肿瘤学家的患者比对照组外科医生和肿瘤学家的患者明显更满意（得分分别为82.06和77.78，P = .03），且感觉更好（88.2%对70.6%，P = .02）。
结论
继续医学教育干预在一些但并非所有医生和患者结果方面是有效的。
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