HIV 护理中的临床医生压力和医患沟通。
Clinician stress and patient-clinician communication in HIV care.
机构信息
UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA 94110, USA.
出版信息
J Gen Intern Med. 2012 Dec;27(12):1635-42. doi: 10.1007/s11606-012-2157-7. Epub 2012 Jul 21.
BACKGROUND
Clinician stress is common, but few studies have examined its relationship with communication behaviors.
OBJECTIVE
To investigate associations between clinician stress and patient-clinician communication in primary HIV care.
DESIGN
Observational study.
PARTICIPANTS
Thirty-three primary HIV clinicians and 350 HIV-infected adult, English-speaking patients at three U.S. HIV specialty clinic sites.
MAIN MEASURES
Clinicians completed the Perceived Stress Scale, and we categorized scores in tertiles. Audio-recordings of patient-clinician encounters were coded using the Roter Interaction Analysis System. Patients rated the quality of their clinician's communication and overall quality of medical care. We used regression with generalized estimating equations to examine associations between clinician stress and communication outcomes, controlling for clinician gender, clinic site, and visit length.
KEY RESULTS
Among the 33 clinicians, 70 % were physicians, 64 % were women, 67 % were non-Hispanic white, and the mean stress score was 3.9 (SD 2.4, range 0-8). Among the 350 patients, 34 % were women, 55 % were African American, 23 % were non-Hispanic white, 16 % were Hispanic, and 30 % had been with their clinicians >5 years. Verbal dominance was higher for moderate-stress clinicians (ratio=1.93, p<0.01) and high-stress clinicians (ratio=1.76, p=0.01), compared with low-stress clinicians (ratio 1.45). More medical information was offered by moderate-stress clinicians (145.5 statements, p <0.01) and high-stress clinicians (125.9 statements, p=0.02), compared with low-stress clinicians (97.8 statements). High-stress clinicians offered less psychosocial information (17.1 vs. 19.3, p=0.02), and patients of high-stress clinicians rated their quality of care as excellent less frequently than patients of low-stress clinicians (49.5 % vs. 66.9 %, p<0.01). However, moderate-stress clinicians offered more partnering statements (27.7 vs. 18.2, p=0.04) and positive affect (3.88 vs. 3.78 score, p=0.02) than low-stress clinicians, and their patients' ratings did not differ.
CONCLUSIONS
Although higher stress was associated with verbal dominance and lower patient ratings, moderate stress was associated with some positive communication behaviors. Prospective mixed methods studies should examine the complex relationships across the continuum of clinician well-being and health communication.
背景
临床医生的压力很常见，但很少有研究探讨其与沟通行为之间的关系。
目的
调查初级 HIV 护理中临床医生压力与医患沟通之间的关联。
设计
观察性研究。
参与者
33 名初级 HIV 临床医生和 350 名在美国 3 个 HIV 专科诊所就诊的感染 HIV 的成年英语患者。
主要措施
临床医生完成了感知压力量表，我们将分数分为三分位。使用 Roter 交互分析系统对医患交流的音频记录进行编码。患者对其临床医生的沟通质量和整体医疗质量进行评分。我们使用广义估计方程回归来检验临床医生压力与沟通结果之间的关联，控制临床医生的性别、诊所地点和就诊时间。
主要结果
在 33 名临床医生中，70%是医生，64%是女性，67%是非西班牙裔白人，平均压力评分为 3.9（SD 2.4，范围 0-8）。在 350 名患者中，34%是女性，55%是非洲裔美国人，23%是非西班牙裔白人，16%是西班牙裔，30%与他们的临床医生相处时间超过 5 年。中度压力的临床医生（比值=1.93，p<0.01）和高压力的临床医生（比值=1.76，p=0.01）的言语支配性更高，而非低压力的临床医生（比值 1.45）。中度压力的临床医生提供的医疗信息更多（145.5 条，p<0.01）和高压力的临床医生（125.9 条，p=0.02），而非低压力的临床医生（97.8 条）。高压力的临床医生提供的心理社会信息较少（17.1 比 19.3，p=0.02），高压力的临床医生的患者对其医疗服务质量的评价不如低压力的临床医生（49.5%比 66.9%，p<0.01）。然而，与低压力的临床医生相比，中度压力的临床医生提供了更多的合作性陈述（27.7 比 18.2，p=0.04）和积极的情绪（3.88 比 3.78 分，p=0.02），而他们的患者评价则没有差异。
结论
尽管较高的压力与言语支配和较低的患者评分相关，但中度压力与某些积极的沟通行为相关。前瞻性混合方法研究应检查临床医生健康和健康沟通的幸福感连续体上的复杂关系。
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