UNC Lineberger Comprehensive Cancer Center and UNC Eshelman School of Pharmacy, The University of North Carolina, Chapel Hill, NC, USA.
Texas Medical Center, University of Texas, Houston, TX, USA.
Health Expect. 2017 Dec;20(6):1385-1392. doi: 10.1111/hex.12579. Epub 2017 Jun 21.
Patient-clinician communication is thought to be central to care outcomes, but when and how communication affects patient outcomes is not well understood.
We propose a conceptual model and classification framework upon which the empirical evidence base for the impact of patient-clinician communication can be summarized and further built.
We use the proposed model and framework to summarize findings from two recent systematic reviews, one evaluating the use of shared decision making (SDM) on cancer care outcomes and the other evaluating the role of physician recommendation in cancer screening use.
Using this approach, we identified clusters of studies with positive findings, including those relying on the measurement of SDM from the patients' perspective and affective-cognitive outcomes, particularly in the context of surgical treatment decision making. We also identify important gaps in the literature, including the role of SDM in post-surgical treatment and end-of-life care decisions, and those specifying particular physician communication strategies when recommending cancer screening.
Transparent linkages between key conceptual domains and the influence of methodological approaches on observed patient outcomes are needed to advance our understanding of how and when patient-clinician communication influences patient outcomes. The proposed conceptual model and classification framework can be used to facilitate the translation of empirical evidence into practice and to identify critical gaps in knowledge regarding how and when patient-clinician communication impacts care outcomes in the context of cancer and health care more broadly.
医患沟通被认为是医疗效果的核心，但沟通何时以及如何影响患者的治疗结果还不是很清楚。
我们提出了一个概念模型和分类框架，以便对医患沟通影响的实证证据进行总结，并进一步构建。
我们使用所提出的模型和框架来总结最近两项系统评价的结果，其中一项评估了在癌症护理结果中使用共享决策（SDM）的情况，另一项评估了医生推荐在癌症筛查使用中的作用。
使用这种方法，我们确定了具有积极发现的研究集群，包括那些依赖于从患者角度测量 SDM 和情感认知结果的研究，特别是在手术治疗决策的背景下。我们还发现文献中的一些重要空白，包括 SDM 在手术后治疗和临终关怀决策中的作用，以及在推荐癌症筛查时指定特定医生沟通策略的研究。
为了深入了解医患沟通如何以及何时影响患者的治疗结果，需要在关键概念领域和方法学方法对观察到的患者结果的影响之间建立透明的联系。所提出的概念模型和分类框架可以用于促进将实证证据转化为实践，并确定关于医患沟通如何以及何时影响癌症和更广泛的医疗保健护理结果的知识空白。
