Prouty Carolyn D, Mazor Kathleen M, Greene Sarah M, Roblin Douglas W, Firneno Cassandra L, Lemay Celeste A, Robinson Brandi E, Gallagher Thomas H
Department of Medicine, University of Washington, Seattle, WA, USA.
J Gen Intern Med. 2014 Aug;29(8):1122-30. doi: 10.1007/s11606-014-2769-1. Epub 2014 Mar 6.
Communication breakdowns in cancer care are common and represent a failure in patient-centered care. While multiple studies have elicited patients' perspectives on these breakdowns, little is known about cancer care providers' attitudes regarding the causes and potential solutions.
To examine providers' (1) perceptions of the nature and causes of communication breakdowns with patients in cancer care and (2) suggestions for managing and preventing breakdowns.
Qualitative study of nine focus groups held at three sites (Massachusetts, Georgia and Washington).
Fifty-nine providers: 33% primary care physicians, 14% oncologists, 36% nurses, and 17% nurse practitioners, physician assistants, and others.
Directed content analysis of focus group transcripts.
Providers' perceptions of the causes of communication breakdowns fell into three categories: causes related to patients, providers, or healthcare systems. Providers perceived that patients sometimes struggle to understand cancer and health-related information, have unrealistic expectations, experience emotional and psychological distress that interferes with information exchange; and may be reticent to share their confusion or concerns. Providers described their own and colleagues' contributions to these breakdowns as sharing inaccurate, conflicting, or uncoordinated information. Providers also described the difficulty in balancing hope with reality in discussions of prognosis. System issues named by providers included insufficient time with patients, payment systems, and changing protocols that inhibit communication and coordination of care. Potential solutions included greater patient engagement, team coordination, and systems that promote patient feedback.
Providers described multiple causes for communication breakdowns at the patient, provider, and system level. Multi-level interventions that coordinate care and encourage feedback may help to address or prevent communication breakdowns.
癌症护理中的沟通障碍很常见，这代表了以患者为中心的护理的失败。虽然多项研究已了解患者对这些障碍的看法，但对于癌症护理提供者对其原因及潜在解决方案的态度却知之甚少。
研究提供者（1）对癌症护理中与患者沟通障碍的性质和原因的看法，以及（2）对管理和预防障碍的建议。
在三个地点（马萨诸塞州、佐治亚州和华盛顿州）进行的九个焦点小组的定性研究。
59名提供者：33%为初级保健医生，14%为肿瘤学家，36%为护士，17%为执业护士、医师助理及其他人员。
对焦点小组记录进行定向内容分析。
提供者对沟通障碍原因的看法分为三类：与患者、提供者或医疗系统相关的原因。提供者认为，患者有时难以理解癌症及与健康相关的信息，期望不切实际，经历会干扰信息交流的情绪和心理困扰；并且可能不愿分享他们的困惑或担忧。提供者将他们自己及同事对这些障碍的影响描述为提供不准确、相互矛盾或不协调的信息。提供者还描述了在讨论预后时难以平衡希望与现实的问题。提供者提到的系统问题包括与患者相处时间不足、支付系统以及抑制护理沟通与协调的方案变化。潜在解决方案包括提高患者参与度、团队协作以及促进患者反馈的系统。
提供者描述了患者、提供者和系统层面沟通障碍的多种原因。协调护理并鼓励反馈的多层次干预措施可能有助于解决或预防沟通障碍。
