醫患溝通系統評價證據的循證分析_《中國循證醫學雜志》

作者：

衛茂玲 ¹ , 蘇維 ² , 李幼平 ¹ , 康德英 ¹ , 宋儒亮 ³ , 張鳴明 ¹

1. 四川大學華西醫院中國循證醫學中心（成都 610041)； 2. 四川大學華西公共衛生學院（成都 610041）；3. 廣東省律師協會醫療法律專業委員會（廣州 510053）;

關鍵詞：

醫患溝通醫患關系循證醫學系統評價

DOI：

10.7507/1672-2531.20080240

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目的　采用循證醫學文獻質量評價方法，尋找醫患溝通系統評價證據，為建立我國醫患有效溝通模式提供依據。
方法　全面檢索與醫患關系和溝通交流主題相關的中英文系統評價或Meta分析相關文獻，并追索參考文獻及其索引，檢索時間截至2008年3月30日。由兩名評價員獨立篩查文獻，根據系統評價量表（OQAQ）對納入文獻質量進行再評價，如遇分歧討論解決。
結果　共納入與醫患溝通相關的系統評價17篇，OQAQ量表評分，最高9分，最低為3分，其中9個條目平均符合率為66.01%（中位數為6），7～9分段占41.29%（7/17），6分占23.5%（4/17），3～5分段占35.3%（6/17）。影響醫患溝通的主要因素有溝通對象、溝通時間、內容、方式等。溝通策略包括以不同模板分別對病人行為進行引導和對醫護溝通技能進行針對性培訓等。
結論　現有關于醫患溝通的系統評價主要基于歐美國家，這反映出我國相關研究不足。基于現有證據，目前應建立鼓勵溝通機制和文化，主動發現醫患溝通問題和阻斷不良溝通行為，同時關注病人意愿，合理選擇培訓策略，及時評估反饋，以提高醫患溝通滿意度。

引用本文： 衛茂玲,蘇維,李幼平,康德英,宋儒亮,張鳴明. 醫患溝通系統評價證據的循證分析. 中國循證醫學雜志, 2008, 08(12): 1100-1104. doi: 10.7507/1672-2531.20080240 復制

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2.	張鷺鷺, 李靜, 徐祖銘. 主編. 高級醫院管理學. 上海: 第二軍醫大學出版社, 2003.
3.	邱仁宗. 臨床醫師面臨的若干倫理問題, 中國醫院, 2003, 7(4): 18-21.
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9.	Rao M. Fogarty P. What did the doctor say? J Obstet Gynaecol (Lahore), 2007, 27(5): 479-480.
10.	Murden RA, Way DP, Hudson A, et al. Professionalism deficiencies in a first-quarter doctor-patient relationship course predict poor clinical performance in medical school. Acad Med, 2004, 79(10 Suppl): S46-48.
11.	Fallowfield L, Jenkins V, Farewell V, et al. Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet, 2002, 359(9307): 650-656.
12.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
13.	Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44(11): 1271-1278.
14.	Bosch-Capblanch X, Abba K, Prictor M, et al. Contracts between patients and healthcare practitioners for improving patients’ adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004808. DOI: 10.1002/14651858.CD004808.pub3.
15.	McKinstry B, Ashcroft RE, Freeman GK, et al. Interventions for improving patients’ trust in doctors and groups of doctors. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004134. DOI: 10.1002/14651858.CD004134.pub2.
16.	Lewin SA, Skea ZC, Entwistle V, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003267. DOI: 10.1002/14651858.CD003267.
17.	R Urquhart CC, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.
18.	Kinnersley P, Edwards A, Hood K, et al. Interventions before consultations for helping patients address their information needs. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004565. DOI: 10.1002/14651858.CD004565.pub2.
19.	Rao JK, Anderson LA, Inui TS, et al. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care, 2007, 45(4): 340-349.
20.	Griffin SJ, Kinmonth AL, Veltman MW, et al. Effect on healthrelated outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med, 2004, 2(6): 595-608.
21.	Krishna SB, Spencer DC, Griffin J Z, et al. Clinical trials of interactive computerized patient education: implications for family practice. J Fam Pract, 1997, 45(1): 25-33.
22.	Ashenden R, Silagy C, Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract, 1997, 14(2): 160-176.
23.	Wilson A, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. Br J Gen Pract, 2002, 52(485): 1012-1020.
24.	Espallargues M, Valderas JM, Alonso J. Provision of feedback on perceived health status to health care professionals: a systematic review of its impact. Med Care, 2000, 38(2): 175-186.
25.	Moxey A, O’Connell D, McGettigan P, et al. Describing treatment effects to patients. J Gen Intern Med, 2003, 18(11): 948-959.
26.	Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev, 2005, 62(3): 255-99.
27.	Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns, 2004, 52(1): 7-16.
28.	Petrella RJ, Lattanzio CN. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician, 2002, 48: 72-80.
29.	Di Blasi Z, Harkness E, Ernst E, et al. Influence of context effects on health outcomes: a systematic review. Lancet, 2001, 357(9258): 757-762.
30.	Sullivan F, Mitchell E. Has general practitioner computing made a difference to patient care? A systematic review of published reports. BMJ, 1995, 311(7009): 848-852.
31.	Roter DL, Larson S, Shinitzky H, et al. Use of an innovative video feedback technique to enhance communication skills training. Med Educ, 2005, 39(6): 645.
32.	Merckaert I, Libert Y, Razavi D. Communication skills training in cancer care: where are we and where are we going? Curr Opin Oncol, 2005,17(4): 319-330.
33.	Oskay-O¨ zcelik G, Lehmacher DW, Ko¨ nsgen H, et al. Breast cancer patients’expectations in respect of the physician–patient relationship and treatment management results of a survey of 617 patients. Ann Oncol, 2007, 18: 479-484.

1. 江波, 劉景雙. 主編. 醫患關系新論. 大連理工大學出版社. 1998年 3月.
2. 張鷺鷺, 李靜, 徐祖銘. 主編. 高級醫院管理學. 上海: 第二軍醫大學出版社, 2003.
3. 邱仁宗. 臨床醫師面臨的若干倫理問題, 中國醫院, 2003, 7(4): 18-21.
4. 王玉華, 劉剛, 吳錦萍, 等. 云南省醫療糾紛調查分析. 醫學與社會, 2007, 20(9): 33-35.
5. 中國醫師協會. 在全國部分省市調查“醫鬧”的分析報告. 中國衛生產業, 2007, (2): 57-59.
6. 中華醫院管理學會維權與自律工作委員會, 中華醫院管理學會維權工作部.《醫療事故處理條例》實施后醫療糾紛的調查分析. 中國醫院, 2004, 8(3): 8.
7. 滕朝宇, 張德茗. 湘雅二醫院醫患溝通研究. 中國優秀碩士學位論文全文數據庫, 2006.
8. Greene MG, Adelman RD, Friedmann E, et al. Older patient satisfaction with communication during an initial medical encounter. Soc Sci Med, 1994, 8(9): 1279-1288.
9. Rao M. Fogarty P. What did the doctor say? J Obstet Gynaecol (Lahore), 2007, 27(5): 479-480.
10. Murden RA, Way DP, Hudson A, et al. Professionalism deficiencies in a first-quarter doctor-patient relationship course predict poor clinical performance in medical school. Acad Med, 2004, 79(10 Suppl): S46-48.
11. Fallowfield L, Jenkins V, Farewell V, et al. Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet, 2002, 359(9307): 650-656.
12. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
13. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44(11): 1271-1278.
14. Bosch-Capblanch X, Abba K, Prictor M, et al. Contracts between patients and healthcare practitioners for improving patients’ adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004808. DOI: 10.1002/14651858.CD004808.pub3.
15. McKinstry B, Ashcroft RE, Freeman GK, et al. Interventions for improving patients’ trust in doctors and groups of doctors. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004134. DOI: 10.1002/14651858.CD004134.pub2.
16. Lewin SA, Skea ZC, Entwistle V, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003267. DOI: 10.1002/14651858.CD003267.
17. R Urquhart CC, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.
18. Kinnersley P, Edwards A, Hood K, et al. Interventions before consultations for helping patients address their information needs. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004565. DOI: 10.1002/14651858.CD004565.pub2.
19. Rao JK, Anderson LA, Inui TS, et al. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care, 2007, 45(4): 340-349.
20. Griffin SJ, Kinmonth AL, Veltman MW, et al. Effect on healthrelated outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med, 2004, 2(6): 595-608.
21. Krishna SB, Spencer DC, Griffin J Z, et al. Clinical trials of interactive computerized patient education: implications for family practice. J Fam Pract, 1997, 45(1): 25-33.
22. Ashenden R, Silagy C, Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract, 1997, 14(2): 160-176.
23. Wilson A, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. Br J Gen Pract, 2002, 52(485): 1012-1020.
24. Espallargues M, Valderas JM, Alonso J. Provision of feedback on perceived health status to health care professionals: a systematic review of its impact. Med Care, 2000, 38(2): 175-186.
25. Moxey A, O’Connell D, McGettigan P, et al. Describing treatment effects to patients. J Gen Intern Med, 2003, 18(11): 948-959.
26. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev, 2005, 62(3): 255-99.
27. Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns, 2004, 52(1): 7-16.
28. Petrella RJ, Lattanzio CN. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician, 2002, 48: 72-80.
29. Di Blasi Z, Harkness E, Ernst E, et al. Influence of context effects on health outcomes: a systematic review. Lancet, 2001, 357(9258): 757-762.
30. Sullivan F, Mitchell E. Has general practitioner computing made a difference to patient care? A systematic review of published reports. BMJ, 1995, 311(7009): 848-852.
31. Roter DL, Larson S, Shinitzky H, et al. Use of an innovative video feedback technique to enhance communication skills training. Med Educ, 2005, 39(6): 645.
32. Merckaert I, Libert Y, Razavi D. Communication skills training in cancer care: where are we and where are we going? Curr Opin Oncol, 2005,17(4): 319-330.
33. Oskay-O¨ zcelik G, Lehmacher DW, Ko¨ nsgen H, et al. Breast cancer patients’expectations in respect of the physician–patient relationship and treatment management results of a survey of 617 patients. Ann Oncol, 2007, 18: 479-484.

《中國循證醫學雜志》

醫患溝通系統評價證據的循證分析

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《中國循證醫學雜志》

醫患溝通系統評價證據的循證分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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