Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina.
Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
JAMA Intern Med. 2023 Jun 1;183(6):544-553. doi: 10.1001/jamainternmed.2023.0629.
Communication between cardiologists and patients can significantly affect patient comprehension, adherence, and satisfaction. To our knowledge, a coaching intervention to improve cardiologist communication has not been tested.
To evaluate the effect of a communication coaching intervention to teach evidence-based communication skills to cardiologists.
DESIGN, SETTING, AND PARTICIPANTS: This 2-arm randomized clinical trial was performed at outpatient cardiology clinics at an academic medical center and affiliated community clinics, and from February 2019 through March 2020 recruited 40 cardiologists and audio recorded 161 patients in the preintervention phase and 240 in the postintervention phase. Data analysis was performed from March 2022 to January 2023.
Half of the cardiologists were randomized to receive a coaching intervention that involved three 1:1 sessions, 2 of which included feedback on their audio-recorded encounters. Communication coaches taught 5 skills derived from motivational interviewing: (1) sitting down and making eye contact with all in the room, (2) open-ended questions, (3) reflective statements, (4) empathic statements, and (5) "What questions do you have?"
Coders unaware of study arm coded these behaviors in the preintervention and postintervention audio-recorded encounters (objective communication). Patients completed a survey after the visit to report perceptions of communication quality (subjective communication).
Analysis included 40 cardiologists (mean [SD] age, 47 [9] years; 7 female and 33 male) and 240 patients in the postintervention phase (mean [SD] age, 58 [15] years; 122 female, 118 male). When controlling for preintervention behaviors, cardiologists in the intervention vs control arm were more likely to make empathic statements (intervention: 52 of 117 [44%] vs control: 31 of 113 [27%]; P = .05); to ask, "What questions do you have?" (26 of 117 [22%] vs 6 of 113 [5%]; P = .002); and to respond with empathy when patients expressed negative emotions (mean ratio of empathic responses to empathic opportunities, 0.50 vs 0.20; P = .004). These effects did not vary based on patient or cardiologist race or sex. We found no arm differences for open-ended questions or reflective statements and were unable to assess differences in patient ratings due to ceiling effects.
In this randomized clinical trial, a communication coaching intervention improved 2 key communication behaviors: expressing empathy and eliciting questions. Empathic communication is a harder-level skill that may improve the patient experience and information comprehension. Future work should explore how best to assess the effect of communication coaching on patient perceptions of care and clinical outcomes and determine its effectiveness in larger, more diverse samples of cardiologists.
ClinicalTrials.gov Identifier: NCT03464110.
心脏病专家与患者之间的沟通会显著影响患者的理解、依从性和满意度。据我们所知，尚未对改善心脏病专家沟通的沟通辅导干预进行测试。
评估沟通辅导干预措施对教授基于证据的沟通技巧的心脏病专家的效果。
设计、设置和参与者：这是一项在学术医疗中心和附属社区诊所的门诊心脏病学诊所进行的 2 臂随机临床试验，于 2019 年 2 月至 2020 年 3 月期间招募了 40 名心脏病专家，并在干预前阶段对 161 名患者和干预后阶段的 240 名患者进行了音频记录。数据分析于 2022 年 3 月至 2023 年 1 月进行。
一半的心脏病专家被随机分配接受辅导干预，包括 3 次 1:1 的会议，其中 2 次包括对他们的音频记录的反馈。沟通教练教授了 5 项源自动机性访谈的技能：（1）与房间里的所有人坐下来并进行眼神交流，（2）开放式问题，（3）反映性陈述，（4）同理心陈述，以及（5）“你有什么问题？”
不了解研究组的编码员对干预前和干预后音频记录的访谈（客观沟通）中的这些行为进行了编码。患者在就诊后完成了一项调查，以报告对沟通质量的看法（主观沟通）。
分析纳入了 40 名心脏病专家（平均[标准差]年龄为 47[9]岁；7 名女性和 33 名男性）和 240 名在干预后阶段的患者（平均[标准差]年龄为 58[15]岁；122 名女性，118 名男性）。在控制干预前行为后，干预组的心脏病专家更有可能进行同理心陈述（干预组：117 人中的 52 人[44%]，对照组：113 人中的 31 人[27%]；P = .05）；询问“你有什么问题？”（干预组：117 人中的 26 人[22%]，对照组：113 人中的 6 人[5%]；P = .002）；并且在患者表达负面情绪时做出同理心回应（同理心反应与同理心机会的平均比值，0.50 与 0.20；P = .004）。这些效果不因患者或心脏病专家的种族或性别而异。我们没有发现开放性问题或反映性陈述方面的组间差异，并且由于上限效应，我们无法评估患者评分方面的差异。
在这项随机临床试验中，沟通辅导干预措施改善了 2 项关键沟通行为：表达同理心和引出问题。同理心沟通是一种更高级别的技能，可能会改善患者体验和信息理解。未来的工作应探讨如何最好地评估沟通辅导对患者对护理的看法和临床结果的影响，并确定其在更大、更多样化的心脏病专家样本中的有效性。
ClinicalTrials.gov 标识符：NCT03464110。
