Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Division of General Practice/Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Patient Educ Couns. 2020 Oct;103(10):1873-1882. doi: 10.1016/j.pec.2020.04.002. Epub 2020 Apr 17.
To determine the agreement of physician and patient ratings of communication in medical face-to-face consultations.
A systematic search of twelve databases was conducted. Studies investigating agreement between physician and patient ratings of communication in medical face-to-face encounters and reporting interrater agreement were included. Methodological quality was assessed, and study characteristics and physician-patient agreement were narratively summarized. Meta-analysis was conducted for a subsample of the included studies investigating shared decision making.
Of the 17 included studies, ten studies did not demonstrate any correspondence between physician and patient ratings. The remaining seven studies revealed poor to fair absolute agreement (κ between .13 and .42; κ between .31 and .49; 95% CI 0.13 - 0.76) and poor to moderate consistency (r = .17 and .06; r between .39 and .63; p < .05). Meta-analysis of six studies yielded small association (r = .15).
Physicians and patients evaluate communication differently and at best, only slightly agree in their ratings, indicating that the construct of communication is not measurable in a stable manner.
Decision makers and researchers should be aware that they assess different aspects of communication, depending on the perspective examined. PROSPERO registration number: CRD42019120065.
确定医患在面对面医疗咨询中沟通评估的一致性。
对 12 个数据库进行了系统检索。纳入了调查医患在面对面医患互动中沟通评估一致性并报告评价者间一致性的研究。评估了研究方法的质量，并对研究特征和医患一致性进行了叙述性总结。对纳入研究中关于共同决策的亚组进行了荟萃分析。
在纳入的 17 项研究中，有 10 项研究未显示出医生和患者评分之间的任何对应关系。其余 7 项研究显示出较差到适度的绝对一致性（κ 在.13 到.42 之间；κ 在.31 到.49 之间；95%CI 0.13-0.76）和较差到适度的一致性（r =.17 和.06；r 在.39 和.63 之间；p<.05）。对 6 项研究的荟萃分析得出了较小的关联（r =.15）。
医生和患者对沟通的评估方式不同，而且最多只有轻微的一致性，这表明沟通的结构无法以稳定的方式进行测量。
决策者和研究人员应该意识到，他们根据所考察的角度评估沟通的不同方面。PROSPERO 注册号：CRD42019120065。
