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A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness
JAMA Internal Medicine ( IF 39.0 ) Pub Date : 2017-09-01 , DOI: 10.1001/jamainternmed.2017.2005
James A. Tulsky 1 , Mary Catherine Beach 2 , Phyllis N. Butow 3 , Susan E. Hickman 4 , Jennifer W. Mack 5 , R. Sean Morrison 6 , Richard L. Street 7 , Rebecca L. Sudore 8 , Douglas B. White 9 , Kathryn I. Pollak 10
Affiliation  

Importance Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking. Observations Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior. Conclusions Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care.

中文翻译:

医疗保健专业人员与重病患者之间交流的研究议程

重要性 医疗保健专业人员的沟通不畅会导致患有严重疾病的患者遭受身心痛苦。患者可能无法完全了解他们的疾病、预后和治疗方案,或者可能无法获得与其目标一致的医疗护理。尽管有大量研究探索了传播在这种情况下的作用,但仍然存在许多问题,并且缺乏明确的传播研究议程。观察 通过共识会议和随后的活动,我们回顾了科学现状,确定了在理解沟通对患者结果的影响方面的关键证据差距,并为未来的研究制定了议程。我们考虑了 7 个广泛的主题:共同决策、预先护理计划、沟通培训、衡量沟通、关于预后的交流、情绪和严重疾病的交流以及文化问题。我们确定了进一步研究可以大大推动该领域向前发展并帮助加强患者护理的 5 个领域:测量和方法,包括如何确定沟通质量;沟通机制,例如确定患者经历的既诚实又富有同情心的特定临床医生行为,或偏见在临床遭遇中的作用;关注重病沟通质量而不是简单填写表格的预先护理计划的替代方法;教授和传播沟通技巧;和方法,例如经济激励和其他临床医生激励因素,以改变沟通行为。
更新日期:2017-09-01
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