Roter D L, Hall J A, Kern D E, Barker L R, Cole K A, Roca R P
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md, USA.
Arch Intern Med. 1995 Sep 25;155(17):1877-84.
Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters.
To explore the effect of communication-skills training on the process and outcome of care associated with patients' emotional distress.
A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients' emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits.
Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months.
Important changes in physicians' communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.
尽管初级保健患者中情绪困扰的发生率很高，但在常规医疗问诊过程中往往未被识别。
探讨沟通技能培训对与患者情绪困扰相关的医疗过程及结果的影响。
对69名初级保健医生及其648名患者进行了一项随机对照现场试验。医生被随机分为无培训对照组或两个旨在帮助医生处理患者情绪困扰的沟通技能培训课程之一。这两个培训课程分别通过问题定义技能或情绪处理技能来解决沟通问题。研究医生的所有门诊就诊均进行录音，直至根据患者对一般健康问卷的回答纳入5名情绪困扰患者和5名非情绪困扰患者。医生在对模拟患者进行访谈以评估临床熟练度时也进行录音。在录音门诊就诊后2周、3个月和6个月，对情绪困扰患者进行电话监测，了解其医疗服务利用情况和一般健康问卷得分。
对实际患者和模拟患者的录音分析表明，经过培训的医生比未经过培训的医生显著更多地使用问题定义和情绪处理技能，且没有增加就诊时间。经过培训的医生还报告了更多的心理社会问题，在与实际患者管理情绪问题方面采用了更多策略，并且在对模拟患者的临床熟练度评分中更高。经过培训的医生的患者报告情绪困扰减少长达6个月。
在一个8小时的课程之后，医生的沟通技能出现了显著变化。该培训改善了医疗过程和结果，且没有延长就诊时间。
