Chhabra Karan R, Pollak Kathryn I, Lee Stephanie J, Back Anthony L, Goldman Roberta E, Tulsky James A
Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
Patient Educ Couns. 2013 Dec;93(3):573-8. doi: 10.1016/j.pec.2013.08.023. Epub 2013 Sep 4.
To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations.
Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists.
Physicians frequently "broadcasted" information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients' goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation.
Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation.
Techniques such as open-ended questions, affirmations of patients' expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations.
描述专科医生在二次诊断咨询中的沟通方式及其对共同决策的潜在影响。
对20例血液肿瘤专科医生的二次诊断咨询进行主题导向话语分析。
医生经常在冗长且往往不间断的独白中“播报”有关疾病、治疗方案、相关研究和预后信息。他们的沟通方式有两种影响之一：传达选项但不提供具体建议，或者推荐一种方案但未将患者的目标和价值观纳入决策。然而，一些医生使用了鼓励患者参与的技巧。
为支持共同决策，“播报”可能是传达复杂治疗信息的次优方法。干预措施可以教授鼓励患者参与的技巧。
诸如开放式问题、肯定患者表达以及停顿以检查患者理解情况等技巧，可以减轻“播报”的影响，并可用于在信息密集的专科咨询中促进共同决策。
