Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Palliat Med. 2010 Mar;13(3):255-60. doi: 10.1089/jpm.2009.0221.
It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills.
Cross-sectional observational study of audio-recorded conversations between patients and physicians.
Three outpatient oncology practices.
Ninety-four patients with advanced cancer and 52 physicians.
None.
Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate.
In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p < 0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p < 0.001). Physicians who used more metaphors elicited better patient ratings of communication (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p < 0.001).
The use of metaphors and analogies may enhance physicians' ability to communicate.
目前尚不清楚医生使用隐喻和类比的频率，也不清楚这是否能改善患者对医生有效沟通能力的看法。因此，本研究的目的是确定在困难的对话中使用隐喻和类比是否与患者对医生沟通技巧的评价更好相关。
对患者和医生之间的音频记录对话进行横断面观察性研究。
三家门诊肿瘤诊所。
94 名晚期癌症患者和 52 名医生。
无。
对对话进行回顾并编码，以确定隐喻和类比的存在。患者还完成了对医生沟通能力的 6 项评分。
在 101 次对话的样本中，编码员确定了 193 个隐喻和 75 个类比。隐喻出现在对话中的次数大约是类比的两倍（65/101，64%比 31/101，31%；符号检验 p < 0.001）。对话中也包含了更多的隐喻而不是类比（平均 1.6，范围 0-11 比平均 0.6，范围 0-5；符号秩检验 p < 0.001）。使用更多隐喻的医生会获得患者对沟通的更高评价（rho = 0.27；p = 0.006），使用更多类比的医生也是如此（Spearman rho = 0.34；p < 0.001）。
使用隐喻和类比可以增强医生的沟通能力。
