1 Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina , Charleston, South Carolina.
J Palliat Med. 2014 Apr;17(4):453-62. doi: 10.1089/jpm.2013.0388. Epub 2014 Mar 20.
Effective physician communication at the end-of-life is a cornerstone to providing patient-centered palliative care. Educational programs in physician communication often rely on self-assessments of physician knowledge and attitudes and seldom provide patients' reports. Thus, it is unclear whether physician self-assessments are associated with patient perspectives.
To determine whether physician trainees' self-assessments of their communication skills in religious/spiritual discussions were associated with assessments obtained from patients under their care.
Prospective, observational, survey-based study of internal medicine trainees' self-assessments matched with their patients' reports. Data were obtained from preintervention surveys prior to the trainees participating in a communication educational intervention.
The study took place at two internal medicine training programs, one in the southeastern United States and one in the northwestern United States. Our subjects were 181 physician trainees in internal medicine and 541 patients with advanced medical illnesses under their care.
The outcomes were patient reports of the occurrence of religious/spiritual communication and patient ratings of the quality of this communication. The primary predictor of interest was trainees' preintervention self-assessments of their competency in religious/spiritual communication.
Using multiple variable and path analysis we found that trainees' self-assessments of their communication skills in religious/spiritual communication was significantly and positively associated with their patients' reports of the occurrence and ratings of religious/spiritual communication.
Physician trainee self-assessments may be a valid surrogate for patient ratings of quality with respect to religious/spiritual communication. This specific domain of physician-patient communication should receive further investigation as our finding contrasts with reports of more general measures of physician-patient end-of-life communication.
在生命末期进行有效的医患沟通是提供以患者为中心的姑息治疗的基石。医生沟通方面的教育计划通常依赖于医生对自身知识和态度的自我评估，而很少提供患者的报告。因此，尚不清楚医生的自我评估是否与患者的观点相关。
确定医师实习生对其在宗教/精神讨论中沟通技巧的自我评估是否与他们所照顾的患者的评估相关。
对内科实习生的自我评估与患者报告进行前瞻性、观察性、基于调查的研究。这些数据是在实习生参加沟通教育干预之前的干预前调查中获得的。
这项研究在美国东南部和西北部的两个内科培训项目中进行。我们的研究对象是 181 名内科医师实习生和 541 名患有晚期疾病的患者。
结果是患者对宗教/精神交流的发生的报告和患者对这种交流质量的评分。主要预测指标是实习生在宗教/精神交流方面的干预前自我评估的能力。
通过多变量和路径分析，我们发现实习生对宗教/精神交流的沟通技能的自我评估与患者对宗教/精神交流的发生和评分的报告显著正相关。
医师实习生的自我评估可能是患者对宗教/精神交流质量评分的有效替代指标。这种医患沟通的特定领域应进一步研究，因为我们的发现与更普遍的医生与临终患者沟通的措施的报告相矛盾。
