Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
BMJ Open. 2023 Sep 21;13(9):e073584. doi: 10.1136/bmjopen-2023-073584.
Discussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care.
Pre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups.
Three Swiss teaching hospitals.
Adult patients hospitalised for medical care.
We analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics.
The primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes.
Of the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (±14.6) vs 90.2 (±12.1), adjusted difference -2.5 (95% CI -4.28 to -0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient-physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002).
A large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients.
NCT03210987.
在查房过程中讨论敏感话题（如医疗不确定性、社会问题、不遵医嘱）具有挑战性，并且可能会对患者对所接受医疗服务的满意度产生负面影响。在之前的一项侧重于查房期间沟通的多中心随机 BEDSIDE-OUTSIDE 试验中，我们研究了敏感话题与护理满意度低之间的相互作用。
对一项随机对照试验的预先计划的二次分析。在这项分析中，来自干预组的原始试验数据被汇总。
瑞士三所教学医院。
因医疗护理住院的成年患者。
我们分析了从查房期间录制的录音带中记录的预定敏感健康主题和特定沟通要素，适用于处理和不处理敏感主题的患者。
主要终点是患者对护理的整体满意度；使用 0 到 100 的视觉模拟量表进行测量。次要终点包括查房时间和进一步的满意度结果。
在 919 名纳入的患者中，有 474 名患者至少有一个敏感话题，包括医疗不确定性（n=251）、精神共病（n=161）、肿瘤诊断（n=137）和社会问题（n=125）。与没有敏感话题的患者相比，有敏感话题的患者对护理的满意度较低（平均值（标准差），87.7（±14.6）与 90.2（±12.1），调整差异-2.5（95%CI-4.28 至-0.72），p=0.006）。在有敏感话题的患者中，低满意度的危险因素包括一些与医患互动有关的参数，例如查房期间的分歧（平均值（标准差），14/212（6.6%）与 41/254（16.1%），调整后的 OR 2.78（95%CI 1.47 至 5.27），p=0.002）。
很大一部分住院患者必须处理敏感的健康话题。这与护理满意度降低有关，尤其是如果患者认为查房期间与医生的互动不满意。对医生进行特定沟通技巧的教育可能有助于改善对这些患者的护理。
NCT03210987。
