Department of Psychological Sciences, University of Liverpool, Whelan Building, Brown low Hill, Liverpool, L69 3GB, UK.
Department of Psychological Sciences, University of Liverpool, Whelan Building, Brown low Hill, Liverpool, L69 3GB, UK.
Patient Educ Couns. 2017 Nov;100(11):2138-2140. doi: 10.1016/j.pec.2017.05.019. Epub 2017 Jun 19.
Clinical communication literature currently distinguishes clinicians' emotional care of patients from instrumental aspects of clinical care, and regards clinicians' explicit emotional engagement with patients as the key to emotional care. Here we critically appraise this view.
We draw on empirical evidence and recent reviews and critiques focusing on cancer care.
Patients and families do not generally seek explicit emotional engagement from their practitioners; nor does such engagement consistently improve patient outcomes. Instead some evidence indicates that anxious patients and families can be comforted by clinicians' focus on instrumental care.
Such findings can be interpreted according to the view that clinical relationships evoke attachment processes. In the context of mortal illness, patients are comforted by being able to trust clinicians whom they regard as having the expertize to look after them. From this perspective, instrumental and emotional care are inseparable. Clinicians' clinical authority and expertize are the basis for the emotional comfort they can provide.
For researchers and educators, a consequence of appreciating the inseparability of emotional and instrumental care will be greater emphasis on learning from, and collaborating with, clinicians. Clinicians, in turn, can benefit by communication scientists developing new approaches to supporting their communication. These approaches will need to recognize that clinicians' emphasis on their authority and clinical expertize in communicating with patients can be central to providing emotional comfort, and not necessarily a way to avoid doing so.
临床沟通文献目前将临床医生对患者的情感关怀与临床护理的工具性方面区分开来，并将临床医生与患者明确的情感投入视为情感关怀的关键。在这里，我们批判性地评价这一观点。
我们借鉴了关注癌症护理的实证证据和近期的综述和批评。
患者和家属通常并不期望从他们的医生那里获得明确的情感投入；这种投入也不一定能始终改善患者的结局。相反，有证据表明，焦虑的患者和家属可以从临床医生对工具性护理的关注中得到安慰。
这些发现可以根据临床关系引发依恋过程的观点来解释。在身患绝症的情况下，患者能够信任他们认为有专业知识照顾他们的医生，从而感到安慰。从这个角度来看，工具性护理和情感关怀是不可分割的。临床医生的临床权威和专业知识是他们能够提供情感安慰的基础。
对于研究人员和教育工作者来说，认识到情感关怀和工具性关怀的不可分割性的一个后果是，将更加重视向临床医生学习和合作。反过来，沟通科学家开发新方法来支持他们的沟通，这也将使临床医生受益。这些方法需要认识到，临床医生在与患者沟通时强调自己的权威和临床专业知识可以是提供情感安慰的核心，而不一定是回避这种做法的方式。
