CeMPED, School of Psychology, University of Sydney, NSW, Australia.
Patient Educ Couns. 2011 Feb;82(2):233-9. doi: 10.1016/j.pec.2010.04.001.
To assess the relative impact of cognitive and emotional aspects of shared decision making (SDM) on patient outcomes.
Cognitive and emotional aspects of SDM in consultations between 20 oncologists and 55 early breast cancer patients were coded using the Observing Patient Involvement (OPTION) scale and the Response to Emotional Cues and Concerns (RECC) coding system, plus blocking and facilitating behaviour scales. Patient outcomes including anxiety, decisional conflict, and satisfaction with: (i) the decision, (ii) the consultation, and (iii) doctor SDM skills, were assessed. Relationships between cognitive and emotional aspects of SDM, and patient outcomes were examined using hierarchical regression.
The OPTION score predicted satisfaction with doctor SDM skills 2 weeks post-consultation (p=.010), and with the treatment decision 4 months post-consultation (p=.004). Emotional blocking predicted decisional conflict (p=.039), while the number of emotional cues emitted (p=.003), and the degree of empathy provided (p=.011), predicted post-consultation anxiety.
Cognitive and emotional aspects of SDM in oncology consultations have different effects on various patient outcomes.
It is important that doctors focus on both sharing decisions and managing emotions in consultations. Communication skills training addressing both these areas may be an effective way to improve diverse patient outcomes.
评估共同决策（SDM）的认知和情感方面对患者结局的相对影响。
使用观察患者参与度（OPTION）量表和情感线索与关注反应（RECC）编码系统，以及阻断和促进行为量表，对 20 名肿瘤学家与 55 名早期乳腺癌患者咨询中的 SDM 的认知和情感方面进行编码。评估患者结局，包括焦虑、决策冲突以及对以下方面的满意度：（i）决策，（ii）咨询，和（iii）医生 SDM 技能。使用分层回归检验 SDM 的认知和情感方面与患者结局之间的关系。
OPTION 评分可预测咨询后 2 周时对医生 SDM 技能的满意度（p=.010），以及咨询后 4 个月时对治疗决策的满意度（p=.004）。情感阻断预测决策冲突（p=.039），而情绪线索的数量（p=.003）和提供的同理心程度（p=.011）预测咨询后的焦虑。
肿瘤学咨询中 SDM 的认知和情感方面对各种患者结局有不同的影响。
医生关注共享决策和咨询中的情绪管理非常重要。解决这两个方面的沟通技巧培训可能是改善各种患者结局的有效方法。
