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在与模拟晚期癌症患者进行决策过程中,医生对其不确定性管理满意度的预测因素。

Predictors of physicians' satisfaction with their management of uncertainty during a decision-making encounter with a simulated advanced stage cancer patient.

作者信息

Libert Y, Canivet D, Ménard C, Van Achte L, Farvacques C, Merckaert I, Liénard A, Klastersky J, Reynaert C, Slachmuylder J-L, Durieux J-F, Delvaux N, Razavi D

机构信息

Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium.

Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Service de psychologie, Hopital Universitaire Erasme, Brussels, Belgium.

出版信息

Patient Educ Couns. 2016 Jul;99(7):1121-1129. doi: 10.1016/j.pec.2016.01.008. Epub 2016 Jan 21.

Abstract

OBJECTIVES

To optimize their training, predictors of physicians' satisfaction with their management of uncertainty should be examined. This study investigated these predictors by using a simulated advanced stage cancer patient.

METHODS

Physicians (n=85) rated their satisfaction with their management of uncertainty (Visual Analog Scale-100mm) after a decision-making encounter. Communication predictors were examined with the: Observing Patient Involvement scale (OPTION), Multidimensional analysis of Patient Outcome Predictions (MD.POP) and Communication Content Analysis Software (LaComm). Psychological predictors were assessed with the: Intolerance of Uncertainty Inventory (IUI), Physicians' Reactions to Uncertainty scale (PRU), Decisional Conflict Scale (DCS), and Jefferson Scale of Physician Empathy (JSPE).

RESULTS

Physicians' satisfaction (mean=67mm; standard deviation=17mm) was not predicted by their communication, but by their anxiety due to uncertainty (PRU) (β=-.42; p=<.001) and their perceived empathy (JSPE) (β=.26; p=.009). These variables accounted for 25% of variance in physicians' satisfaction.

CONCLUSIONS

Physicians' satisfaction with their management of uncertainty was not affected by their communication performance, but by their psychological characteristics.

PRACTICE IMPLICATIONS

Training programs should increase physicians' awareness regarding the communication performance required in decision-making encounters under conditions of uncertainty.

摘要

目的

为优化培训,应对医生对不确定性管理满意度的预测因素进行研究。本研究通过使用模拟晚期癌症患者来调查这些预测因素。

方法

85名医生在一次决策性会诊后,对他们对不确定性管理的满意度(视觉模拟量表-100毫米)进行评分。使用观察患者参与量表(OPTION)、患者结果预测多维分析(MD.POP)和沟通内容分析软件(LaComm)来检查沟通预测因素。使用不确定性不耐受量表(IUI)、医生对不确定性的反应量表(PRU)、决策冲突量表(DCS)和杰斐逊医生同理心量表(JSPE)来评估心理预测因素。

结果

医生的满意度(平均值=67毫米;标准差=17毫米)并非由他们的沟通情况预测,而是由他们因不确定性产生的焦虑(PRU)(β=-.42;p=<.001)和他们感知到的同理心(JSPE)(β=.26;p=.009)所预测。这些变量解释了医生满意度中25%的方差。

结论

医生对不确定性管理的满意度不受其沟通表现的影响,而是受其心理特征的影响。

实践意义

培训项目应提高医生对在不确定性条件下决策性会诊中所需沟通表现的认识。

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