Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands.
Department of Tranzo Scientific Centre for Care and Well-being, Tilburg University, Tilburg, Netherlands.
BMC Palliat Care. 2020 Oct 7;19(1):152. doi: 10.1186/s12904-020-00658-2.
Patients have a 'need to know' (instrumental need) and a 'need to feel known' (affective need). During consultations with patients with limited health literacy (LHL) in the palliative phase of their disease, both the instrumental and the affective communication skills of healthcare providers are important. The study aims to explore instrumental and affective communication between care providers and LHL patients in the palliative phase of COPD or cancer.
In 2018, consultations between LHL patients in the palliative phase of cancer or COPD and their healthcare providers were video-recorded in four hospitals in the Netherlands. As there was no observation algorithm available for this setting, several items were created to parameterize healthcare providers' instrumental communication (seven items: understanding, patient priorities, medical status, treatment options, treatment consequences, prognosis, and information about emotional distress) and affective communication (six items: hope, support, reassurance, empathy, appreciation, and emotional coping). The degree of each item was recorded for each consultation, with relevant segments of the observation selected and transcribed to support the items.
Consultations between 17 care providers and 39 patients were video-recorded and analyzed. Care providers primarily used instrumental communication, most often by giving information about treatment options and assessing patients' care priorities. Care providers assessed patients' understanding of their disease less often. The patients' prognosis was not mentioned in half the consultations. Within the affective domain, the care providers did provide support for their patients; providing hope, reassurance, empathy, and appreciation and discussing emotional coping were observed less often.
Care providers used mostly instrumental communication, especially treatment information, in consultations with LHL patients in the palliative phase of cancer or COPD. Most care providers did not check if the patient understood the information, which is rather crucial, especially given patients' limited level of health literacy. Healthcare providers did provide support for patients, but other expressions of affective communication by care providers were less common. To adapt the communication to LHL patients in palliative care, care providers could be less wordy and reduce the amount of information, use 'teach-back' techniques and pay more attention to affective communication.
患者有“知情权”（工具性需求）和“被了解感”（情感性需求）。在为处于疾病终末期且健康素养有限的患者进行诊疗时，医护人员的工具性和情感性沟通技巧都很重要。本研究旨在探索医护人员与处于终末期慢性阻塞性肺疾病（COPD）或癌症的低健康素养患者之间的工具性和情感性沟通。
2018 年，荷兰四家医院对处于癌症或 COPD 终末期且健康素养有限的患者与其医护人员的诊疗过程进行了视频录制。由于该环境下尚无观察算法，故创建了若干条目来对医护人员的工具性沟通（七项：理解、患者优先事项、病情、治疗选择、治疗后果、预后和情绪困扰信息）和情感性沟通（六项：希望、支持、保证、共情、欣赏和情绪应对）进行参数化处理。为每一次诊疗记录每项的程度，并选择相关的观察片段进行转录，以支持条目。
共对 17 名医护人员与 39 名患者的 39 次诊疗进行了视频录制和分析。医护人员主要采用工具性沟通，最常提供的是关于治疗选择的信息，并评估患者的护理重点。医护人员较少评估患者对其疾病的理解程度。有一半的诊疗中未提及患者的预后。在情感领域，医护人员确实为患者提供了支持；提供希望、保证、共情、欣赏和讨论情绪应对的情况则较少见。
医护人员在对癌症或 COPD 终末期且健康素养有限的患者进行诊疗时，主要使用工具性沟通，尤其是治疗信息。大多数医护人员并未检查患者是否理解了信息，而这一点至关重要，特别是考虑到患者有限的健康素养水平。医护人员确实为患者提供了支持，但医护人员较少进行其他情感性沟通表达。为了使沟通适应终末期的低健康素养患者，医护人员可以少说话，减少信息量，使用“回述”技巧，并更加关注情感性沟通。
