Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Icahn School of Medicine at Mount Sinai, Department of General Internal Medicine, New York, New York, USA.
BMJ Qual Saf. 2017 Nov;26(11):892-898. doi: 10.1136/bmjqs-2016-006181. Epub 2017 Jun 27.
Relatively little attention has been devoted to the role of communication between physicians as a mechanism for individual and organisational learning about diagnostic delays. This study's objective was to elicit physicians' perceptions about and experiences with communication among physicians regarding diagnostic delays in cancer.
DESIGN, SETTING, PARTICIPANTS: Qualitative analysis based on seven focus groups. Fifty-one physicians affiliated with three New York-based academic medical centres participated, with six to nine subjects per group. We used content analysis to identify commonalities among primary care physicians and specialists (ie, medical and surgical oncologists).
Perceptions and experiences with physician-to-physician communication about delays in cancer diagnosis.
Our analysis identified five major themes: openness to communication, benefits of communication, fears about giving and receiving feedback, infrastructure barriers to communication and overcoming barriers to communication. Subjects valued communication about cancer diagnostic delays, but they had many concerns and fears about providing and receiving feedback in practice. Subjects expressed reluctance to communicate if there was insufficient information to attribute responsibility, if it would have no direct benefit or if it would jeopardise their existing relationships. They supported sensitive approaches to conveying information, as they feared eliciting or being subject to feelings of incompetence or shame. Subjects also cited organisational barriers. They offered suggestions that might facilitate communication about delays.
Addressing the barriers to communication among physicians about diagnostic delays is needed to promote a culture of learning across specialties and institutions. Supporting open and honest discussions about diagnostic delays may help build safer health systems.
医生之间的沟通在个体和组织学习诊断延迟方面的作用相对较少受到关注。本研究旨在了解医生对癌症诊断延迟相关的医生间沟通的看法和经验。
设计、地点和参与者：基于 7 个焦点小组的定性分析。51 名来自纽约 3 家学术医疗中心的医生参与了研究，每组 6-9 人。我们使用内容分析法来识别初级保健医生和专科医生（即医学和外科肿瘤学家）之间的共同点。
对医生间沟通癌症诊断延迟的看法和经验。
我们的分析确定了五个主要主题：沟通的开放性、沟通的益处、对提供和接受反馈的担忧、沟通的基础设施障碍以及克服沟通障碍。研究对象重视关于癌症诊断延迟的沟通，但他们在实践中对提供和接受反馈存在许多担忧和顾虑。如果没有足够的信息来归因责任、如果没有直接的好处或如果会危及他们现有的关系，他们就不愿意进行沟通。他们支持以敏感的方式传达信息，因为他们担心引起或受到无能或羞耻感的影响。研究对象还提到了组织障碍。他们提出了一些可能有助于沟通延迟的建议。
需要解决医生之间在诊断延迟方面的沟通障碍，以促进跨专业和机构的学习文化。支持关于诊断延迟的坦诚讨论可能有助于建立更安全的医疗系统。
