Marino Filomena, Alby Francesca, Zucchermaglio Cristina, Scalisi Teresa Gloria, Lauriola Marco
Department of Social and Developmental Psychology, Sapienza Università di Roma, 00185 Roma, Italy.
Cancers (Basel). 2023 May 31;15(11):3008. doi: 10.3390/cancers15113008.
Effective communication is crucial in cancer care due to the sensitive nature of the information and the psychosocial impact on patients and their families. Patient-centered communication (PCC) is the gold standard for providing quality cancer care, as it improves patient satisfaction, treatment adherence, clinical outcomes, and overall quality of life. However, doctor-patient communication can be complicated by ethnic, linguistic, and cultural differences. This study employed the ONCode coding system to investigate PCC practices in oncological visits (doctor's communicative behavior, patient's initiatives, misalignments, interruptions, accountability, and expressions of trust in participants' talk, Markers of uncertainty in doctor's talk, markers of emotions in doctor's talk). Forty-two video-recorded patient-oncologist encounters (with 22 Italian and 20 foreign patients), including both first and follow-up visits, were analyzed. Three discriminant analyses were conducted to assess differences in PCC between patient groups (Italian or foreign patients) according to the type of encounter (first visit or follow-up) and the presence or absence of companions during the encounters. Multiple regression analyses were performed to evaluate the PCC differences by oncologist age, patient age, and patient sex, controlling for the type of encounter, the presence of a companion during the visit, and patient group on ONCode dimensions. No differences were found in PCC by patient group in discriminant analyses and regressions. Doctor communication behavior, interruptions, accountability, and expressions of trust were higher in first visits than in follow-ups. The disparities in PCC were primarily linked to the type of visit and the age of the oncologist. However, a qualitative analysis showed notable differences in the types of interruptions during visits with foreign patients compared to Italian patients. It is essential to minimize interruptions during intercultural encounters to foster a more respectful and conducive environment for patients. Furthermore, even when foreign patients demonstrate sufficient linguistic competence, healthcare providers should not solely rely on this factor to ensure effective communication and quality care.
由于癌症护理信息的敏感性以及对患者及其家属的心理社会影响，有效的沟通至关重要。以患者为中心的沟通（PCC）是提供优质癌症护理的黄金标准，因为它能提高患者满意度、治疗依从性、临床结果以及整体生活质量。然而，医患沟通可能会因种族、语言和文化差异而变得复杂。本研究采用ONCode编码系统来调查肿瘤诊疗中的PCC实践（医生的沟通行为、患者的主动性、不一致性、打断、问责以及参与者谈话中信任的表达、医生谈话中不确定性的标志、医生谈话中情感的标志）。分析了42次视频记录的患者与肿瘤医生的会诊（其中22名意大利患者和20名外国患者），包括初次就诊和随访。进行了三项判别分析，以评估根据会诊类型（初次就诊或随访）以及会诊期间是否有陪同人员，患者组（意大利患者或外国患者）之间在PCC方面的差异。进行了多元回归分析，以评估肿瘤医生年龄、患者年龄和患者性别对PCC差异的影响，同时控制会诊类型、就诊期间陪同人员的存在以及患者组在ONCode维度上的情况。在判别分析和回归分析中，未发现患者组之间在PCC方面存在差异。初次就诊时医生的沟通行为、打断、问责以及信任表达高于随访时。PCC的差异主要与就诊类型和肿瘤医生的年龄有关。然而，定性分析表明，与意大利患者相比，外国患者就诊期间的打断类型存在显著差异。在跨文化会诊期间尽量减少打断对于为患者营造一个更尊重和有益的环境至关重要。此外，即使外国患者表现出足够的语言能力，医疗服务提供者也不应仅依赖这一因素来确保有效的沟通和优质的护理。
