National Institute on Minority Health and Health Disparities, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Division of Intramural Research, National Institute on Minority Health and Health Disparities, USA.
Patient Educ Couns. 2018 Dec;101(12):2186-2194. doi: 10.1016/j.pec.2018.08.021. Epub 2018 Aug 22.
Patient-clinician communication (PCC) may generate or reduce healthcare disparities. This paper is based on the 2017 International Conference on Communication in Healthcare keynote address and reviews PCC literature as a research area for the National Institute on Minority Health and Health Disparities (NIMHD).
A narrative review of selected evidence on disparities in PCC experienced by race and ethnic minorities, associations between PCC and poor health outcomes, and patient and clinician factors related to PCC.
Factors associated with poor quality PCC on the patient level include being a member of racial/ethnic minority, having limited English proficiency, and low health and digital literacy; on the clinician level, being less culturally competent, lacking communication skills to facilitate shared decision-making, and holding unconscious biases. Recommendations include offering patient- and/or clinician-targeted interventions to guard against unconscious biases and improve PCC, screening patients for health literacy and English proficiency, integrating PCC in performance processes, and leveraging health information technologies to address unconscious biases.
EffectivePCC is a pathway to decrease health disparities and promote health equity.
Standardized collection of social determinants of health in the Electronic Health Record is an importantfirst step in promoting more effective PCC.
医患沟通（PCC）可能会产生或减少医疗保健方面的差异。本文基于 2017 年国际医疗保健交流大会的主题演讲，并将医患沟通文献作为国家少数民族健康和健康差异研究所（NIMHD）的一个研究领域进行回顾。
对种族和少数民族在医患沟通方面的差异、医患沟通与不良健康结果之间的关联以及与医患沟通相关的患者和临床医生因素等方面的证据进行了选择性的叙述性回顾。
与沟通质量差相关的患者因素包括属于少数族裔、英语水平有限以及健康和数字素养较低；临床医生方面的因素包括文化能力较差、缺乏促进共同决策的沟通技巧以及存在无意识偏见。建议包括提供针对患者和/或临床医生的干预措施以防范无意识偏见并改善医患沟通、对患者的健康素养和英语水平进行筛查、将医患沟通纳入绩效流程以及利用健康信息技术解决无意识偏见。
有效的医患沟通是减少健康差异和促进健康公平的途径。
在电子健康记录中标准化收集健康的社会决定因素是促进更有效的医患沟通的重要第一步。
