Culver Julie O, Bowen Deborah J, Reynolds Susan E, Pinsky Linda E, Press Nancy, Burke Wylie
Department of Bioethics and Humanities, University of Washington, Seattle, Washington 98195, USA.
Genet Med. 2009 Oct;11(10):735-41. doi: 10.1097/GIM.0b013e3181b2e5eb.
To assess primary care providers' communication about breast cancer risk.
We evaluated 86 primary care providers' communication of risk using unannounced standardized (simulated) patients. Physicians were randomly assigned to receive one of three cases: (1) moderate risk case (n = 25), presenting with a breast lump and mother with postmenopausal breast cancer; (2) high-risk (maternal side) case (n = 28), presenting with concern about breast cancer risk; and (3) high-risk (paternal side) case (n = 33), presenting with an unrelated problem. After the appointment, three qualitative parameters were assessed by standardized patients on a 3-point scale (3 = highest satisfaction, 1 = lowest): whether the physician took adequate time; acknowledged her concerns; and offered reassurance.
Mean satisfaction with physician communication was higher for the moderate risk case (2.92) than for the high-risk paternal case (2.25) or high-risk maternal case (2.42) (P < 0.0001). The score was not influenced by session length, medical specialty, or physician gender.
Physicians more consistently provided a moderate risk standardized patients with reassurance and support compared with the high-risk cases. Primary care physicians may be more unprepared or uneasy addressing the issues raised by more complex scenarios and may benefit from training in the assessment and communication of breast cancer risk.
评估基层医疗服务提供者关于乳腺癌风险的沟通情况。
我们使用未事先通知的标准化（模拟）患者评估了86名基层医疗服务提供者的风险沟通情况。医生被随机分配接受三种病例之一：（1）中度风险病例（n = 25），表现为乳腺肿块且母亲患有绝经后乳腺癌；（2）高风险（母系家族）病例（n = 28），表现出对乳腺癌风险的担忧；（3）高风险（父系家族）病例（n = 33），表现出一个不相关的问题。就诊结束后，标准化患者以3分制（3 =最高满意度，1 =最低满意度）评估三个定性参数：医生是否花了足够的时间；是否承认她的担忧；以及是否给予了安慰。
中度风险病例中患者对医生沟通的平均满意度（2.92）高于高风险父系家族病例（2.25）或高风险母系家族病例（2.42）（P < 0.0001）。该评分不受就诊时长、医学专业或医生性别的影响。
与高风险病例相比，医生更一致地为中度风险的标准化患者提供了安慰和支持。基层医疗医生可能对处理更复杂情况中出现的问题准备不足或感到不安，可能会从乳腺癌风险评估和沟通方面的培训中受益。
