Chuang Elizabeth, Lamkin Richard, Hope Aluko A, Kim Gina, Burg Jean, Gong Michelle Ng
Department of Family and Social Medicine, Palliative Care Service, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
J Pain Symptom Manage. 2017 Jul;54(1):27-34. doi: 10.1016/j.jpainsymman.2017.03.011. Epub 2017 May 4.
Terminally ill hospitalized patients and their families consistently rank effective communication and shared decision-making among their top priorities. Advance practice providers such as physician assistants (PAs) are increasingly providing care in the hospital setting and are often called to communicate with patients and families. A first step to improving PA communication is to better understand PAs' current experiences in their daily practices.
This study aimed to explore roles PAs serve in communicating with terminally ill patients/families; PAs' attitudes and opinions about communication roles; and perceived barriers and facilitators of communication with patients/families in the hospital setting.
Five focus groups were conducted with PAs practicing on adult medical services at three acute care hospitals of an academic medical center in Bronx, New York. An open-ended question guide was used. An inductive thematic analysis strategy was used to examine the data from transcribed audiotapes of focus group sessions to identify emergent concepts and themes.
The overarching theme that emerged was being stuck in the middle. PAs experienced ambiguity around their roles and responsibilities in communications between the medical team as well as patients and families; gaps in knowledge and skills; and organizational or structural deficits in the patient care systems that placed them in uncomfortable situations.
Interventions aimed at improving PA communication with terminally ill patients and their families should target institutional structures, systems, and culture around roles and responsibilities in addition to skill and knowledge gaps to be most effective.
晚期住院患者及其家属一直将有效的沟通和共同决策列为他们的首要任务。医师助理（PA）等高级执业提供者越来越多地在医院环境中提供护理，并且经常被要求与患者及其家属进行沟通。改善医师助理沟通的第一步是更好地了解他们在日常工作中的当前经历。
本研究旨在探讨医师助理在与晚期患者/家属沟通中所扮演的角色；医师助理对沟通角色的态度和看法；以及在医院环境中与患者/家属沟通时所感知到的障碍和促进因素。
在纽约布朗克斯区一家学术医疗中心的三家急症医院，对从事成人医疗服务的医师助理进行了五个焦点小组访谈。使用了开放式问题指南。采用归纳主题分析策略，对焦点小组会议录音转录的数据进行分析，以识别新出现的概念和主题。
出现的总体主题是“陷入两难境地”。医师助理在医疗团队与患者及家属之间的沟通中，对自己的角色和职责感到模糊；存在知识和技能差距；患者护理系统中的组织或结构缺陷使他们处于不舒服的境地。
旨在改善医师助理与晚期患者及其家属沟通的干预措施，除了针对技能和知识差距外，还应针对围绕角色和职责的机构结构、系统和文化，这样才最有效。
