Department of Communication, Texas A&M University, College Station, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Houston VA Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.
Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA.
Patient Educ Couns. 2017 Aug;100(8):1612-1618. doi: 10.1016/j.pec.2017.03.021. Epub 2017 Mar 18.
To critically examine properties of clinician-patient communication measures and offer suggestions for selecting measures appropriate to the purposes of research or clinical practice assessment.
We analyzed different types of communication measures by focusing on their ontological properties. We describe their relative advantages and disadvantages with respect to different types of research questions.
Communication measures vary along dimensions of reporter (observer vs. participant), focus of measurement (behavior, meaning, or quality), target, and timing. Observer coded measures of communication behavior function well as dependent variables (e.g., evaluating communication skill interventions, examining variability related to gender or race), but are less effective as predictors of perceptions and health outcomes. Measures of participants' judgments (e.g., what the communication means or how well it was done) capture patients' or clinicians' experiences (e.g., satisfaction) and can be useful for predicting outcomes, especially in longitudinal designs.
In the absence of a theoretically coherent set of measures that could be used across research programs and applied setting, users should take steps to select measures with properties that are optimally matched to specific questions.
Quality assessments of clinician-patient communication should take into account the timing of the assessment and use measures that drill down into specific aspects of patient experience to mitigate ceiling effects.
批判性地考察医患沟通测量工具的特性，并就如何选择适合研究或临床实践评估目的的测量工具提供建议。
我们通过关注沟通测量工具的本体论特性，对不同类型的沟通测量工具进行了分析。我们根据不同类型的研究问题，描述了它们的相对优缺点。
沟通测量工具在报告者（观察者与参与者）、测量重点（行为、意义或质量）、目标和时间等维度上存在差异。观察者编码的沟通行为测量工具在作为因变量（例如，评估沟通技能干预、检查与性别或种族相关的变异性）方面表现良好，但作为感知和健康结果的预测指标效果较差。参与者判断的测量工具（例如，沟通的含义或完成情况如何）可以捕捉患者或临床医生的体验（例如满意度），并可用于预测结果，尤其是在纵向设计中。
在缺乏一套可以跨研究计划和应用环境使用的理论上一致的测量工具的情况下，使用者应采取措施选择具有最佳特性的测量工具，以满足特定问题的需求。
医患沟通的质量评估应考虑评估的时间，并使用能够深入了解患者体验特定方面的测量工具，以减轻上限效应。
