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Du J, Mayer G, Posenato E, Hummel S, Zafar A, Bärnighausen T, Schultz JH. Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:783. [PMID: 36371188 PMCID: PMC9652837 DOI: 10.1186/s12909-022-03830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The Chinese healthcare system is affected by frequent disputes between physicians and patients. Although recent reforms have contributed towards improving the patient-physician relationship, distrust in physicians is still high. Communication skills (CS) training of physicians holds the key to improving patient confidence and diffusing stressful situations. This survey reports on the status of CS training in medical education in China, and the experiences and attitudes of physicians towards CS training. METHODS A cross-sectional survey was conducted at medical institutions across China. A questionnaire developed for this study included the status of CS training, current aspects of patient-physician relationships, perceived own CS and patient-centeredness with Likert-scaled items from 1 (most negative) to 6 (most positive). Physicians' attitude towards CS training was measured with the Communication Skills Attitude Scale (CSAS) and its subscales PAS (Positive Attitude Scale) and NAS (Negative Attitude Scale). Data were analyzed descriptively and for group differences between the hospital level and operating vs. non-operating physicians. Binary logistic regression analysis was done to find associations explaining the occurrence of verbal and physical attacks and the role of CS attitudes. RESULTS Out of 1080 questionnaires, 772 physicians met inclusion criteria. A total of 466/772 participants (60.4%) had received at least one CS training during their career. The participants rated the current situation related to patient-physician relationship in China as highly stressful (mean = 4.52, SD = 1.26, 95% CI: 4.43-4.60), experiencing verbal attacks in the past three years once a year in 372/772 cases (48.2%) and physical attacks 111/772 times (14.4%). The mean PAS was 62.96 (SD = 7.63, 95% CI: 62.41-63.47). Being female was associated with increased risk of verbal attacks (OR = 1.51, 95% CI: 1.01-2.25) while working in a tertiary hospital and showing high levels of PAS decreased this risk (OR = 0.62, 95% CI: 0.43-0.89, and OR = 0.95, 95% CI: 0.93-0.98). Having received a previous CS training decreased the odds of physical attacks (OR = 0.54, 95% CI: 0.35-0.83). CONCLUSIONS A majority of Chinese physicians showed a high positive attitude towards CS training, were trained in CS and would value further training. Our results highlight that CS training is likely to promote patient-centered communication and reduce attacks against physicians. Both of these effects are to improve the patient-physician-relationship in the long run. More CS training should be offered to Chinese physicians, especially at secondary- and primary-care hospitals, where such practices remain infrequent.
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Affiliation(s)
- Junfeng Du
- Department of Plastic Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gwendolyn Mayer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Elisabetta Posenato
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Svenja Hummel
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Zafar
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Liu X, Humphris G, Luo A, Yang M, Yan J, Huang S, Xiao S, Lv A, Wu G, Gui P, Wang Q, Zhang Y, Yan Y, Jing N, Xu J. Family-clinician shared decision making in intensive care units: Cluster randomized trial in China. PATIENT EDUCATION AND COUNSELING 2022; 105:1532-1538. [PMID: 34657779 DOI: 10.1016/j.pec.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/30/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate if a Family-Clinician Shared Decision-Making (FCSDM) intervention benefits patients, families and intensive care units (ICUs) clinicians. METHODS Six ICUs in China were allocated to intervention or usual care. 548 patients with critical illness, 548 family members and 387 ICU clinicians were included into the study. Structured FCSDM family meetings were held in the intervention group. Scales of SSDM, HADS, QoL2 and CSACD were used to assess families' satisfaction and distress, patients' quality of life, and clinicians' collaboration respectively. RESULTS Comparing the intervention group with the control group at post-intervention, there were significant differences in the families' satisfaction (P = 0.0001), depression level (P = 0.005), and patients' quality of life (P = 0.0007). The clinicians' mean CSCAD score was more positive in the intervention group than controls (P < 0.05). There was no significant between-group differences on ICU daily medical cost, but the intervention group demonstrated shorter number of days' stay in ICU (P = 0.0004). CONCLUSION The FCSDM intervention improved families' satisfaction and depression, shortened patients' duration of ICU stay, and enhanced ICU clinicians' collaboration. PRACTICE IMPLICATIONS Further improvement and promotion of the FCSDM model are needed to provide more evidence to this field in China.
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Affiliation(s)
- Xinchun Liu
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Gerald Humphris
- Health Psychology, School of Medicine, University of St. Andrews, Scotland, UK
| | - Aijing Luo
- Key Laboratory of Medical Information Research (Central South University, College of Hunan Province), Hunan, China
| | - Mingshi Yang
- Intensive Care Unit, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shaohua Huang
- Intensive Care Unit, The First Changsha Hospital, Changde, Hunan, China
| | - Siyu Xiao
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ailian Lv
- Intensive Care Unit, The First Changsha Hospital, Changde, Hunan, China
| | - Guobao Wu
- Intensive Care Unit, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peigen Gui
- Intensive Care Unit, The Second Affiliated Hospital Nanhua University, Hengyang, Hunan, China
| | - Qingyan Wang
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yudong Zhang
- Intensive Care Unit, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yaxin Yan
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Nie Jing
- Intensive Care Unit, Hunan Provincial Tumor Hospital, Changsha, Hunan, China
| | - Jie Xu
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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