沟通方式对乳癌患者满意度的影响

　　患者与医疗服务提供者之间的沟通，可以影响患者的满意度，但是沟通方式对乳癌患者满意度的影响尚不明确。

　　2019年4月25日，施普林格·自然《乳腺癌研究与治疗》在线发表美国耶鲁大学医学院、耶鲁癌症中心、耶鲁纽黑文医院、沃特伯里圣玛丽医院、芭芭拉希利事务所、英国皇家马斯登医院的研究报告，探讨了沟通方式对乳癌患者满意度的影响。

　　该单中心问卷调查研究于2017年7月19日～2018年5月9日由耶鲁大学斯米洛肿瘤医院乳腺中心邀请患者常规随访复诊期间完成人口统计学简表、沟通方式评定、健康调查问卷、加拿大多伦多大学玛格丽特公主医院制定的患者对医生满意度问卷，医师和资深医疗服务提供者也被要求完成沟通方式评定，患者和医疗服务提供者对彼此问卷反馈双盲。通过沟通方式一致性评分，计算每对医疗服务提供者与患者80项沟通方式评定的皮尔逊相关系数。通过混合效应模型，评定患者满意度评分的影响因素。

　　结果，共邀请330例患者参加，其中289例入组、245例完成问卷、174例完成所有调查问卷项目，18位医疗服务提供者完成沟通方式评定。

　　对患者满意度影响最大的因素包括：

• 生理健康（效应值：0.0058，95%置信区间：0.00051～0.0011，P=0.032）

• 就业状况（效应值：0.12，95%置信区间：-0.0094～0.25，P=0.069）

　　不过，当患者与医疗服务提供者的沟通方式比较相似时，失业和生理健康较差患者的满意度评分反而显著较高（效应值：1.52，95%置信区间：0.66～2.38，P=0.0016）。

　　因此，该研究结果表明，生理健康较好和就业患者通常对其医疗比较满意。患者与医疗服务提供者的沟通方式相似性，对于生理健康较差和失业患者满意度的影响较大。

Breast Cancer Res Treat. 2019 Apr 25.

The impact of communication style on patient satisfaction.

Amelia A. Trant, Borbala Szekely, Sarah S. Mougalian, Michael P. DiGiovanna, Tara Sanft, Erin Hofstatter, Andrea Silber, Kerin B. Adelson, Anees Chagpar, Brigid Killelea, Nina Horowitz, Donald Lannin, Tristen Park, Michelle Corso, Gineesha Abraham, Karen Pollard-Murphy, Tracy Sturrock, Elspeth Knill-Selby, Ashley Western, Camille Servodidio, Marios Konstantinos Tasoulis, Barbara Healy, Christos Hatzis, Lajos Pusztai.

Yale School of Medicine, New Haven, USA; National Institute of Oncology, New Haven, USA; Yale-New Haven Health System, New Haven, USA; St. Mary's Hospital, Waterbury, USA; The Royal Marsden NHS Foundation Trust, London, UK; Barbara Healy Associates, Cheshire, USA.

BACKGROUND: Communication between patients and health providers influences patient satisfaction, but it is unknown whether similarity in communication styles results in higher patient satisfaction.

METHODS: This study was conducted in the Smilow Cancer Hospital Breast Center. During routine follow-up visits, patients completed a Communication Styles Assessment (CSA), health survey (SF-12), Princess Margaret Hospital Satisfaction with Doctor Questionnaire, and brief demographic form. Physicians and Advanced Practice Providers were also asked to complete the CSA. Patients and providers were blinded to each other's responses. A communication styles concordance score was calculated as the Pearson correlation between 80 binary CSA items for each provider/patient pair. Factors affecting patient satisfaction scores were assessed in mixed-effects models.

RESULTS: In total, 330 patients were invited to participate; of these 289 enrolled and 245 returned surveys. One hundred seventy-four completed all survey components, and 18 providers completed the CSA. Among the factors considered, physical health score (effect size=0.0058, 95% CI 0.00051 to 0.0011, p=0.032) and employment status (0.12, 95% CI -0.0094 to 0.25, p=0.069) had the greatest impact on patient satisfaction. However, patients who were not employed and less physically healthy had significantly elevated satisfaction scores when their communication style was more similar to their provider's (1.52, 95% CI 0.66 to 2.38, p=0.0016).

CONCLUSIONS: Patients who were physically healthy and employed were generally more satisfied with their care. The similarity in communication styles of patients and providers had a greater impact on patient satisfaction for patients who were less physically healthy and not employed.

KEYWORDS: Patient satisfaction Communication styles Breast cancer

DOI: 10.1007/s10549-019-05232-w