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证据回顾与沟通技巧及医患关系的建议:罗马基金会工作组报告。

A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report.

机构信息

Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina.

Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia.

出版信息

Gastroenterology. 2021 Nov;161(5):1670-1688.e7. doi: 10.1053/j.gastro.2021.07.037. Epub 2021 Jul 28.


DOI:10.1053/j.gastro.2021.07.037
PMID:34331912
Abstract

BACKGROUND & AIMS: Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS: The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. RESULTS: Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS: We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.

摘要

背景与目的:几十年来,医疗保健的变化对医患之间有意义的沟通产生了负面影响,并对他们的关系产生了不利影响。在时间压力不断增加的情况下,医生更多地依赖技术而不是面对面的时间来收集数据以做出临床决策。因此,他们发现更难以理解疾病背景并充分满足患者的需求。患者会感到不满,并在护理过程中削弱自己的角色。对于患有肠脑互动障碍的患者,由于没有明显的结构基础来使症状合理化,因此耻辱感会导致更大的护理不满。最近的证据表明,实用的沟通技巧可以改善医患关系(PPR)和临床结果,但这些数据有限。

方法:罗马基金会召集了一个多学科工作组,旨在通过进行循证审查来研究沟通技巧对患者满意度和结果的影响:a)研究沟通技巧对患者满意度和结果的影响;b)分析社会文化因素、医疗保健系统限制、患者视角和远程医疗对 PPR 的影响;c)审查沟通技巧培训对这些结果的测量和影响;d)提出改善沟通技巧培训和 PPR 的建议。

结果:有证据表明,针对医患互动的干预措施可以改善人口健康、患者和提供者的体验以及成本。沟通技巧培训可提高患者满意度和结果。以下是建立有效的 PPR 时需要考虑的相关因素:解决医疗保健系统限制;纳入社会文化因素以及性别、年龄和慢性疾病的作用;并考虑远程医疗对 PPR 的影响。

结论:我们的结论是,有效的沟通技巧可以改善 PPR 和健康结果。通过培训和系统变革可以实现这一目标。需要进一步的研究来证实这些发现。

相似文献

[1]
A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report.

Gastroenterology. 2021-11

[2]
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Gastroenterology. 2017-12-22

[3]
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Gastroenterology. 2022-1

[4]
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[5]
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JBI Database System Rev Implement Rep. 2015-1

[6]
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Evid Rep Technol Assess (Summ). 2001-8

[7]
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Can J Gastroenterol. 2009-12

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[9]
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