“关键不在你说了什么……”：骨科医生与患者沟通中的种族差异
"It's not what you say ...": racial disparities in communication between orthopedic surgeons and patients.
作者信息
Levinson Wendy, Hudak Pamela L, Feldman Jacob J, Frankel Richard M, Kuby Alma, Bereknyei Sylvia, Braddock Clarence
机构信息
Department of Medicine, University of Toronto, Ontario, Canada.
出版信息
Med Care. 2008 Apr;46(4):410-6. doi: 10.1097/MLR.0b013e31815f5392.
BACKGROUND
Excellent communication between surgeons and patients is critical to helping patients to make informed decisions and is a key component of both high quality of care and patient satisfaction. Understanding racial disparities in communication is essential to provide quality care to all patients.
OBJECTIVE
To examine the content and process of informed decision-making (IDM) between orthopedic surgeons and elderly white versus African American patients. To assess the association of race and patient satisfaction with surgeon communication.
RESEARCH DESIGN
Analysis of audiotape recordings of office visits between orthopedic surgeons and patients.
PARTICIPANTS
Eighty-nine orthopedic surgeons and 886 patients age 60 years or older in Chicago, Illinois.
METHODS
Tapes were analyzed by coders for content using 9 elements of IDM and for process using 4 global ratings of the relationship-building component of communication (responsiveness, respect, listening, and sharing). Ratings by race were compared using chi analysis. Patients completed a questionnaire rating satisfaction with surgeon communication and the visit overall. Logistic analysis was used to assess the effect of race on satisfaction.
RESULTS
Overall there were practically no significant differences in the content of the 9 IDM elements based on race. However, coder ratings of relationship were higher on 3 of 4 global ratings (responsiveness, respect, and listening) in visits with white patients compared with African American patients (P < 0.01). Patient ratings of communication and overall satisfaction with the visit were significantly higher for white patients.
CONCLUSIONS
The content of IDM conversations does not differ by race. Yet differences in the process of relationship building and in patient satisfaction ratings were clearly present. Efforts to enhance cultural communication competence of surgeons should emphasize the skills of building relationships with patients in addition to the content of IDM.
背景
外科医生与患者之间良好的沟通对于帮助患者做出明智的决策至关重要，是高质量医疗服务和患者满意度的关键组成部分。了解沟通中的种族差异对于为所有患者提供优质医疗服务至关重要。
目的
研究骨科医生与老年白人患者和非裔美国患者之间知情决策（IDM）的内容和过程。评估种族与患者对医生沟通满意度之间的关联。
研究设计
分析骨科医生与患者门诊就诊的录音。
参与者
伊利诺伊州芝加哥的89名骨科医生和886名60岁及以上的患者。
方法
编码人员使用IDM的9个要素对录音内容进行分析，并使用沟通中关系建立部分的4个总体评分（反应性、尊重、倾听和分享）对过程进行分析。使用卡方分析比较种族评分。患者完成一份问卷，对医生沟通和总体就诊满意度进行评分。使用逻辑分析评估种族对满意度的影响。
结果
总体而言，基于种族的9个IDM要素的内容几乎没有显著差异。然而，与非裔美国患者相比，白人患者就诊时，在4个总体评分中的3个（反应性、尊重和倾听）上，编码人员对关系的评分更高（P < 0.01）。白人患者对沟通和总体就诊满意度的评分明显更高。
结论
IDM对话的内容不因种族而异。然而，关系建立过程和患者满意度评分方面的差异明显存在。提高外科医生文化沟通能力的努力除了IDM的内容外，还应强调与患者建立关系的技巧。
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