Brown Stephen D, Callahan Michael J, Browning David M, Lebowitz Robert L, Bell Sigall K, Jang Jisun, Meyer Elaine C
Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Boston, Massachusetts.
Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
J Am Coll Radiol. 2014 Aug;11(8):781-7. doi: 10.1016/j.jacr.2014.01.018. Epub 2014 Mar 27.
The aim of this study was to assess the effect of communication skills training on radiology trainees' (1) comfort with communicating directly with patients and family members about unexpected or difficult diagnoses ("bad news"), radiologic errors, and radiation risks and (2) attitudes about disclosing radiologic errors directly to patients and their families.
One hundred nine radiology trainees from 16 US programs were asked to complete questionnaires immediately before and after attending an institutional review board-exempted, full-day communication workshop. Questionnaires assessed (1) comfort communicating with patients and their families generally and about bad news, radiologic errors, and radiation risks specifically; (2) attitudes and behavioral intent regarding a hypothetical vignette involving a radiologic error; and (3) desire for additional communication training.
All trainees completed the questionnaires. After completing the workshop, more trainees reported comfort communicating with patients about bad news, errors, and radiation risks (pre vs post, 44% vs 73%, 25% vs 44%, and 34% vs 58%, respectively, P < .001 for all). More also agreed that the radiologist in the error vignette should discuss the error with the patient (pre vs post, 84% vs 95%; P = .002) and apologize (pre vs post, 78% vs 94%; P < .001). After participation, fewer trainees reported unwillingness to disclose the error despite medicolegal concerns (pre vs post, 39 vs 15%; P < .001). Despite high baseline comfort (92%) and low stress (14%) talking with patients in general, most respondents after participation desired additional communication training on error disclosure (83%), general communication (56%), and radiation risks (80%).
This program provides effective communication training for radiology trainees. Many trainees desire more such programs.
本研究旨在评估沟通技能培训对放射科住院医师的影响：（1）与患者及家属就意外或疑难诊断（“坏消息”）、放射学错误和辐射风险进行直接沟通时的舒适度；（2）对直接向患者及其家属披露放射学错误的态度。
来自美国16个项目的109名放射科住院医师在参加一个经机构审查委员会豁免的全天沟通研讨会之前和之后，被要求立即完成问卷调查。问卷评估了：（1）与患者及其家属一般沟通以及具体就坏消息、放射学错误和辐射风险进行沟通时的舒适度；（2）关于一个涉及放射学错误的假设性案例的态度和行为意图；（3）对额外沟通培训的需求。
所有住院医师都完成了问卷调查。完成研讨会后，更多住院医师报告在与患者就坏消息、错误和辐射风险进行沟通时感到舒适（之前与之后分别为44%对73%、25%对44%、34%对58%，所有P <.001）。更多人也同意错误案例中的放射科医生应该与患者讨论错误（之前与之后分别为84%对95%；P =.002）并道歉（之前与之后分别为78%对94%；P <.001）。参与之后，报告尽管存在法医学顾虑但仍不愿意披露错误的住院医师减少（之前与之后分别为39%对15%；P <.001）。尽管大多数受访者在与患者一般交谈时基线舒适度较高（92%）且压力较低（14%），但参与之后大多数受访者仍希望就错误披露（83%）、一般沟通（56%）和辐射风险（80%）接受更多沟通培训。
该项目为放射科住院医师提供了有效的沟通培训。许多住院医师希望有更多这样的项目。
