Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Intern Med. 2017 Sep 1;177(9):1361-1366. doi: 10.1001/jamainternmed.2017.2005.
Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking.
Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior.
Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care.
医疗保健专业人员沟通不畅会导致重病患者身体和心理上的痛苦。患者可能无法充分了解自己的病情、预后和治疗选择，或者可能无法接受符合其治疗目标的医疗护理。尽管有大量研究探索了这一环境下的沟通作用，但仍存在许多问题，缺乏明确的沟通研究议程。
通过共识会议和随后的活动，我们回顾了科学现状，确定了理解沟通对患者结局影响的关键证据差距，并为未来的研究制定了议程。我们考虑了 7 个广泛的主题：共同决策、预先护理计划、沟通培训、沟通测量、预后沟通、情感和严重疾病沟通以及文化问题。我们确定了 5 个可以进一步推动该领域发展并有助于改善患者护理的领域：测量和方法，包括如何确定沟通质量；沟通机制，例如确定患者体验到的诚实和富有同情心的具体临床医生行为，或者临床接触中的偏见作用；预先护理计划的替代方法，重点关注严重疾病沟通的质量，而不仅仅是表格的完成；教学和传播沟通技巧；以及改变沟通行为的方法，如经济激励和其他临床医生激励措施。
我们的研究结果强调了迫切需要通过广泛的研究来改善医疗保健专业人员与重病患者之间的沟通质量，这些研究涵盖沟通技巧、工具、患者教育和护理模式。
