Schellenberger Barbara, Heuser Christian, Diekmann Annika, Ansmann Lena, Krüger Emily, Schreiber Leonie, Geiser Franziska, Karger André, Schmidt-Wolf Ingo G H, Milz Katrin, Peisker Uwe, Ernstmann Nicole
Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.
Center for Integrated Oncology (CIO), University Hospital Bonn, Bonn, Germany.
Psychooncology. 2022 Sep;31(9):1597-1606. doi: 10.1002/pon.5999. Epub 2022 Jul 16.
Patients' participation is part of patient-centeredness, but it is so far unclear whether providers in multidisciplinary tumor conferences (MTCs) with patient participation communicate in a patient-centered way. Our aim is to explore (a) to what extent providers ask questions to breast and gynecological cancer patients during case discussion in MTCs, (b) how providers respond to patients' expressions of emotions during case discussions, and (c) which patient- and context-related characteristics and responses are associated with patients' trust in the treatment team after the case discussion.
This observational study included survey data and audio recordings of MTCs with patient participation at three breast and gynecological cancer centers. Providers' questions to patients and responses to patients' emotional expressions were coded using the Verona Coding Definitions of Emotional Sequences. The response can be explicitly or non-explicitly related to the emotion and space-reducing or space-providing. Multiple linear regression analysis was used to determine associations between providers' responses, patient- and context-related characteristics, and patients' trust in the treatment team after the case discussion.
We analyzed 82 case discussions (77 breast, 5 breast and gynecological cancer patients). Providers asked a total of 646 questions, of which 86% were polar (yes/no). Providers gave 303 responses to a total of 230 emotional expressions by patients. Non-explicit responses were associated with more trust when they were space-providing, but with less trust when space-reducing.
The frequency of providers' closed questions and space-reducing responses to emotions shows that patient-centered communication rarely takes place in MTCs with patient participation.
患者参与是患者中心理念的一部分，但目前尚不清楚在有患者参与的多学科肿瘤会议（MTC）中，医护人员是否以患者为中心进行沟通。我们的目的是探讨：（a）在MTC的病例讨论中，医护人员向乳腺癌和妇科癌症患者提问的程度；（b）医护人员在病例讨论中如何回应患者的情感表达；（c）在病例讨论后，哪些与患者及背景相关的特征和回应与患者对治疗团队的信任相关。
这项观察性研究纳入了三个乳腺癌和妇科癌症中心有患者参与的MTC的调查数据和音频记录。使用情感序列的维罗纳编码定义对医护人员向患者提出的问题以及对患者情感表达的回应进行编码。回应可以与情感明确或不明确相关，并且可以是减少空间或提供空间的。使用多元线性回归分析来确定医护人员的回应、与患者及背景相关的特征以及病例讨论后患者对治疗团队的信任之间的关联。
我们分析了82次病例讨论（77例乳腺癌，5例乳腺癌和妇科癌症患者）。医护人员总共提出了646个问题，其中86%是两极问题（是/否）。医护人员对患者总共230次情感表达给出了303次回应。不明确的回应在提供空间时与更多的信任相关，但在减少空间时与更少的信任相关。
医护人员封闭式问题的频率以及对情感减少空间的回应表明，在有患者参与的MTC中很少发生以患者为中心的沟通。
