患者对医生在前列腺癌筛查讨论中的沟通方式的看法：住院医师与教员的比较

Patient perceptions of how physicians communicate during prostate cancer screening discussions: a comparison of residents and faculty.

作者信息

Kerns J William, Krist Alex H, Woolf Steven H, Flores Sharon K, Johnson Robert E

机构信息

Department of Family Medicine, Virginia Commonwealth University, Virginia, USA.

出版信息

Fam Med. 2008 Mar;40(3):181-7.

PMID:18320396

Abstract

BACKGROUND

Residents are required to demonstrate competency in communication skills. Prostate cancer screening discussions are examples of complex physician-patient communication processes, requiring an objective presentation of the known risks, potential benefits, and scientific uncertainties surrounding screening. National organizations recommend shared decision making (SDM) in these discussions.

METHODS

A stratified analysis to contrast resident and faculty outcomes was planned as part of a randomized controlled trial comparing decision aids for prostate cancer screening in a suburban Washington, DC, residency practice. All eligible men between the ages of 50 and 70 years scheduled for a wellness examination with either a resident or a faculty physician were randomly assigned to one of two intervention arms (Web- or paper-based decision aid) or to the control group (no pre-visit education). Patients were asked to complete exit surveys that evaluated their perceptions of key elements of SDM for prostate cancer screening (PCS).

RESULTS

Patients seen by resident physicians were younger than patients seen by faculty, and a smaller proportion had undergone previous prostate-specific antigen (PSA) testing. Patients seen by residents and faculty reported similar levels of the elements of SDM (eg, knowledge about PCS, achieving their desired locus of control for the decision) and similar time spent discussing screening. Both groups also had nearly identical decisional conflict scores and PSA testing rates. Residents discussed more PCS topics (6.3 versus 5.3 topics), including more topics that might influence a patient to decide against screening, than did faculty physicians.

CONCLUSIONS

According to patient perceptions, residents appeared to perform as well as faculty in SDM and other aspects of PCS discussions, although the topics that they covered with patients might have differed.

摘要

背景

住院医师需要证明其具备沟通技能方面的能力。前列腺癌筛查讨论是复杂的医患沟通流程的实例，需要客观呈现围绕筛查的已知风险、潜在益处及科学不确定性。国家组织建议在这些讨论中采用共同决策（SDM）。

方法

作为一项在华盛顿特区郊区住院医师实践中比较前列腺癌筛查决策辅助工具的随机对照试验的一部分，计划进行分层分析以对比住院医师和教员的结果。所有年龄在50至70岁之间、计划由住院医师或教员进行健康检查的符合条件男性被随机分配至两个干预组之一（基于网络或纸质的决策辅助工具）或对照组（就诊前无教育）。患者被要求完成出院调查，评估他们对前列腺癌筛查（PCS）共同决策关键要素的看法。

结果

由住院医师诊治的患者比由教员诊治的患者更年轻，且之前接受过前列腺特异性抗原（PSA）检测的比例更低。由住院医师和教员诊治的患者报告的共同决策要素水平相似（例如，关于PCS的知识、在决策中实现其期望的控制程度），且讨论筛查的时间相似。两组的决策冲突得分和PSA检测率也几乎相同。与教员相比，住院医师讨论的PCS主题更多（6.3个主题对5.3个主题），包括更多可能影响患者决定不进行筛查的主题。