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2018年3月15日，英国《柳叶刀》公共卫生分册增刊在线发表耶鲁大学医学院和公共卫生学院、中南大学湘雅三医院的定性研究摘要，针对中国湖南省长沙市三级甲等教学医院乳腺外科医生与外科患者及其家属的期望与体验，调查了造成中国医生与患者及其家属之间关系紧张的可变沟通因素。 该定性研究于2015年6～8月通过随机抽样入组29位参与者，其中包括11位乳房肿瘤切除手术住院患者、9位相关家属、9位乳腺外科医生。手术前后方便时与患者及其家属进行围手术期深度半结构式访谈，并记录编译为英文，最后进行编码和主题分析。 结果，该研究确定了发生危机的三种情况：第一，医疗服务之前与期间的信任恶化；第二，患者及其家属寻求医疗服务时，蓦然觉得对于疾病一无所知并且无能为力；第三，医生在强大的社会压力下，感到秀才遇到兵有理说不清（习得性无助：心理学名词，个体经历某种学习后，在面临不可控情境时形成无论怎样努力也无法改变事情结果的不可控认知，继而导致放弃努力的一种心理状态）。 因此，该研究结果表明，医生与患者及其家属之间的紧张关系，同时涉及人际关系和体制问题，沟通可以发挥重要作用，故有必要对整个体制进行改革，促进医疗资源的公正、平衡、合理分配，以患者为中心，为患者及其家属提供更好的体验，同时确保医疗服务提供者的权益和安全。 Lancet Glob Health. 2018 Mar 15;6:S53. Communication in the Chinese doctor-patient-family relationship: a qualitative study of expectations and experiences in a breast surgery setting. Siyu C Xiao, Lixuan Wang, Xinchun Liu, Kaveh Khoshnood, E Jennifer Edelman. Yale School of Medicine, New Haven, CT, USA; Yale School of Public Health, New Haven, CT, USA; Third Xiangya Hospital of Central South University, Changsha, China. BACKGROUND: Problems facing the doctor-patient-family relationship in China, including violence against doctors, have received international attention. Possible reasons for tension in the medical relationship include systems-level challenges such as imbalances between provider and patient populations and a biased media. Yet limited empirical work has been done to examine how interpersonal dynamics, particularly communication, between patients, their family members, and providers contribute to satisfaction or tension. The aim of this study was to identify actionable communication factors contributing to tension in the Chinese doctor-patient-family relationship among breast surgeons, surgical patients, and their family members in an urban, tertiary-level teaching hospital in Hunan Province, China. METHODS: We conducted a qualitative study between June and August, 2015. We recruited a convenience sample of 29 participants, including 11 breast lumpectomy inpatients, nine corresponding family members, and nine breast surgeons. In-depth, semi-structured interviews were conducted perioperatively in Mandarin and English, with patients and family members interviewed before and after surgery when possible. Interviews were transcribed and translated into English. Transcripts were coded and a thematic analysis was applied. FINDINGS: We identified three emergent themes. First, trust deteriorated before and during the health-care experience. Second, the health-care-seeking experience for patients and family members was marked by unmet expectations for achieving a basic understanding as well as powerlessness. Third, societal pressures on doctors contributed to a state of learned helplessness. INTERPRETATION: Our findings suggest that tension between doctors, patients, and family members is associated with both interpersonal and structural challenges, with communication having an important role. Reforms at all levels are needed to promote empowerment by providing a more patient-centred experience for patients and family members while ensuring the wellbeing and security of providers. FUNDING: Downs International Health Student Travel Fellowship, Yale School of Public Health; Office of Student Research, Yale School of Medicine. DOI: 10.1016/S2214-109X(18)30182-7 |
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