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功能性胃肠病患者——横断面队列研究中评估医患沟通的重要性

Patients with functional gastrointestinal disorders-importance of communication between physician and patient assessed in a cross-sectional cohort study.

作者信息

Goebel-Stengel Miriam, Paulsen Ute, Bennerscheidt Petra, Zipfel Stephan, Stengel Andreas

机构信息

Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.

Department of Internal Medicine, Helios Clinic, Rottweil, Germany.

出版信息

Front Psychiatry. 2023 Aug 31;14:1252268. doi: 10.3389/fpsyt.2023.1252268. eCollection 2023.

Abstract

Functional gastrointestinal disorders are frequent diseases often associated with a pronounced burden reflected in a greatly reduced quality of life. Patients are seeking medical help but may be perceived as demanding and challenging. For successful diagnosis and treatment of these patients, a good doctor-patient communication is key. However, so far, only few studies focus on the physicians' perspective of the doctor-patient communication. The present study cross-sectionally investigated 520 physicians using the validated difficult doctor-patient relationship questionnaire and the treatment satisfaction questionnaire from the physician's perspective along with several questions. Data from 5,354 physician-patient conversations (one conversation per patient) was included. Physicians participating in this study mostly suspected stress-related burdens as the cause of functional gastrointestinal disorders (65.4%), while patients rather suspected food (55.4%) or other somatic causes (43.6%). The physician-patient relationship was rated just below the threshold for difficult interactions (cut-off ≥30, mean ± SD in the current sample: 28.6 ± 9.6) with 49.1% of physicians reaching a score of ≥30. Although physicians overall felt confident in the doctor-patient communication even in difficult conversations (61.9%), only 33.1% reported to have enough time for these patients and only 5.6% felt sufficiently compensated for discussions with patients with functional gastrointestinal disorders. Therefore, education of physicians on functional gastrointestinal disorders, training of physicians in physician-patient communication as well as an improved reimbursement of speaking medicine should help to further improve care for these patients and also treatment satisfaction on both the side of the patients as well as the physicians.

摘要

功能性胃肠病是常见疾病,常伴有明显负担,表现为生活质量大幅下降。患者寻求医疗帮助,但可能被认为要求苛刻且具有挑战性。对于这些患者的成功诊断和治疗,良好的医患沟通是关键。然而,到目前为止,只有少数研究关注医生对医患沟通的看法。本研究采用经过验证的医患关系困难问卷和医生视角的治疗满意度问卷以及几个问题,对520名医生进行了横断面调查。纳入了来自5354次医患对话(每位患者一次对话)的数据。参与本研究的医生大多怀疑与压力相关的负担是功能性胃肠病的病因(65.4%),而患者则更多怀疑食物(55.4%)或其他躯体原因(43.6%)。医患关系的评分略低于困难互动的阈值(临界值≥30,当前样本中的均值±标准差:28.6±9.6),49.1%的医生得分≥30。尽管医生总体上即使在困难对话中对医患沟通也有信心(61.9%),但只有33.1%的医生报告有足够时间看这些患者,只有5.6%的医生觉得与功能性胃肠病患者讨论得到了足够补偿。因此,对医生进行功能性胃肠病教育、对医生进行医患沟通培训以及改善对健谈诊疗的报销,应有助于进一步改善对这些患者的护理,并提高患者和医生双方的治疗满意度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/782b/10501798/8eccc66cbc08/fpsyt-14-1252268-g001.jpg

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