Outram Sue, Harris Gillian, Kelly Brian, Cohen Martin, Bylund Carma L, Landa Yulia, Levin Tomer T, Sandhu Harsimrat, Vamos Marina, Loughland Carmel
University of Newcastle, Callaghan, Australia,
Acad Psychiatry. 2015 Apr;39(2):174-80. doi: 10.1007/s40596-014-0226-4. Epub 2014 Nov 15.
This research sought to gain insight into the processes used by clinicians to discuss a schizophrenia diagnosis with patients/families, with the aim of informing the development of a communications skills training program.
A generic qualitative methodological approach was used. Sixteen mental health clinicians were recruited. Semi-structured individual interviews were used to explore their perceptions and experiences communicating a schizophrenia diagnosis. Interviews were recorded, transcribed, and thematic analysis undertaken.
There were five key themes relating to the process of communication about a diagnosis of schizophrenia: (1) orientation to patient care, (2) planning of communication, (3) the impact of team leadership and inter/intra-professional functioning on communication tasks, (4) the roles of different clinicians in communicating about diagnosis and treatment, and (5) time and resource deficiencies. Despite expressing care and concern for vulnerable patients and embracing the concept of multidisciplinary teams, communicating diagnostic information to patients and families was generally unplanned for, with little consistency regarding leadership approaches, or how the team communicated diagnostic information to the patient and family. This contributed to tensions between different team members.
The findings demonstrated a number of issues compromising good communication around a schizophrenia diagnosis, both in terms of clinician skill and clinical context, and support the importance of education and training for all members of the multidisciplinary team about their role in the communication process.
本研究旨在深入了解临床医生与患者/家属讨论精神分裂症诊断时所采用的流程，以便为沟通技能培训项目的开发提供参考。
采用通用的定性研究方法。招募了16名心理健康临床医生。通过半结构化的个人访谈来探究他们传达精神分裂症诊断的看法和经历。访谈进行了录音、转录，并开展了主题分析。
与精神分裂症诊断沟通流程相关的有五个关键主题：（1）以患者护理为导向；（2）沟通规划；（3）团队领导以及专业间/专业内协作对沟通任务的影响；（4）不同临床医生在诊断和治疗沟通中的角色；（5）时间和资源不足。尽管临床医生对弱势患者表达了关怀与关切，并接受多学科团队的理念，但向患者和家属传达诊断信息通常缺乏规划，在领导方式以及团队如何向患者和家属传达诊断信息方面几乎没有一致性。这导致了不同团队成员之间的紧张关系。
研究结果表明，在精神分裂症诊断的沟通方面存在诸多问题，这在临床医生技能和临床环境方面都有所体现，同时也支持了对多学科团队所有成员进行关于其在沟通流程中角色的教育和培训的重要性。
