Institut universitaire romand de Santé au Travail (Institute for Work and Health), University of Lausanne & University of Geneva, Route de la Corniche 2, CH-1066 Epalinges, Switzerland.
Int J Psychophysiol. 2017 Oct;120:14-22. doi: 10.1016/j.ijpsycho.2017.06.006. Epub 2017 Jun 27.
Stress is a common phenomenon in medical professions. Breaking bad news (BBN) is reported to be a particularly distressing activity for physicians. Traditionally, the stress experienced by physicians when BBN was assessed exclusively using self-reporting. Only recently, the field of difficult physician-patient communication has used physiological assessments to better understand physicians' stress reactions.
This paper's goals are to (a) review current knowledge about the physicians' psychophysiological stress reactions in BBN situations, (b) discuss methodological aspects of these studies and (c) suggest directions for future research.
The seven studies identified all used scenarios with simulated patients but were heterogeneous with regard to other methodological aspects, such as the psychophysiological parameters, time points and durations assessed, comparative settings, and operationalisation of the communication scenarios. Despite this heterogeneity, all the papers reported increases in psychological and/or physiological activation when breaking bad news in comparison to control conditions, such as history taking or breaking good news.
Taken together, the studies reviewed support the hypothesis that BBN is a psychophysiologically arousing and stressful task for medical professionals. However, much remains to be done. We suggest several future directions to advance the field. These include (a) expanding and refining the conceptual framework, (b) extending assessments to include more diverse physiological parameters, (c) exploring the modulatory effects of physicians' personal characteristics (e.g. level of experience), (d) comparing simulated and real-life physician-patient encounters and (e) combining physiological assessment with a discourse analysis of physician-patient communication.
压力是医疗行业中常见的现象。据报道，传达坏消息（BBN）是医生特别苦恼的活动。传统上，医生在进行 BBN 时所经历的压力仅通过自我报告进行评估。直到最近，困难医患沟通领域才开始使用生理评估来更好地理解医生的应激反应。
本文的目的是：（a）回顾目前关于医生在 BBN 情况下的心理生理应激反应的知识；（b）讨论这些研究的方法学方面；（c）为未来的研究提出方向。
确定的七项研究都使用了模拟患者的情景，但在其他方法学方面存在差异，例如评估的心理生理参数、时间点和持续时间、比较设置以及沟通情景的操作化。尽管存在这种异质性，但所有论文都报告称，与控制条件（如病史采集或传递好消息）相比，在传递坏消息时，心理和/或生理激活增加。
综上所述，综述的研究支持 BBN 对医疗专业人员来说是一种心理生理上令人兴奋和压力大的任务的假设。然而，仍有许多工作要做。我们建议了几个未来的方向来推进该领域。这些包括：（a）扩展和完善概念框架；（b）将评估扩展到包括更多不同的生理参数；（c）探索医生个人特征（例如经验水平）的调节作用；（d）比较模拟和真实医患接触；（e）将生理评估与医患沟通的话语分析相结合。
