Download PDF
Gesundheitswesen 2014; 76(11): 707-714
DOI: 10.1055/s-0033-1361179
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Kommunikationspräferenzen onkologischer Patienten

Communication Preferences of Oncology Patients
E. Farin
1   Qualitätsmanagement und Sozialmedizin, Universitätsklinikum Freiburg, Freiburg
,
W. Baumann
2   Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen-WINHO-GmbH, Köln
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Ziel:

Nach der Prüfung der psychometrischen Eigenschaften eines Fragebogens zur Erfassung der Präferenzen von Patienten bezüglich der Pa­tient-Behandler-Kommunikation (KOPRA-Fragebogen) erfolgt eine Beschreibung der Kommunikationspräferenzen onkologischer Patienten. Dazu wird nach soziodemografischen Untergruppen unterschieden und ein Vergleich mit den Präferenzen von Patienten mit Rückenschmerzen und chronisch-ischämischer Herzkrankheit durchgeführt.

Methode:

Es wurden N=1 635 Patienten aus 31 onkologischen Praxen befragt. Beim KOPRA-Fragebogen wurden Reliabilität, Eindimensionalität und die Passung zum Rasch-Modelle geprüft. Um Subgruppenanalysen und Vergleiche mit anderen Diagnosen durchzuführen, wurden hierarchische Modelle angewandt.

Ergebnisse:

Die psychometrischen Eigenschaften des KOPRA fallen insgesamt befriedigend bis gut aus. Den Patienten sind die 4 mit dem KOPRA erfassten Kommunikationsbereiche (Patientenbeteiligung und Patientenorientierung, effektive und offene Kommunikation, emotional unterstützende Kommunikation, Kommunikation über persönliche Verhältnisse) ähnlich wichtig. Frauen haben generell höhere Erwartungen an das kommunikative Verhalten des Arztes. Affektive Kommunikation ist Krebs-Patienten wesentlich wichtiger als Rückenschmerzpatienten oder kardiologischen Patienten.

Schlussfolgerung:

Der KOPRA-Fragebogen ist für die Untersuchung von Kommunikationspräferenzen onkologischer Patienten gut geeignet. In der Regel ist ein Arztverhalten optimal, welches auf allen 4 KOPRA-Dimensionen hohe Werte aufweist. Insbesondere in Fällen, wo die 4 Kommunikationsanforderungen in Konflikt zueinander treten, sollte eine Individualisierung des ärztlichen Kommunikationsstils erfolgen.

Abstract

Purpose:

After testing the psychometric properties of a new questionnaire that measures patient preferences for patient-physician communication (KOPRA questionnaire), the communication preferences of cancer patients were described. In order to do this, the preferences were differentiated according to sociodemographic subgroups and a comparison was made to the preferences of patients with chronic back pain and chronic ischaemic heart disease.

Methods:

N=1 635 patients from 31 medical oncology practices were surveyed. For the KOPRA questionnaire, reliability, unidimensionality, and fit to the Rasch model were tested. Hierarchical models were used to conduct subgroup analyses and comparisons with other diseases.

Results:

The psychometric properties of the KOPRA are satisfactory to good. For patients, the 4 communication domains (patient participation and patient orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances) measured by the KOPRA questionnaire are equally important. Women generally have higher expectations of the physician’s communicative behaviour. Affective communication is considerably more important for cancer patients than for back pain or cardiac patients.

Conclusion:

The KOPRA questionnaire is well suited for examining the communication preferences of cancer patients. In general, physician behaviour associated with high scores in all 4 KOPRA dimensions is optimal. Especially in cases where the 4 communication aspects conflict with each other, the physician’s communication style should be individualised.

Schlüsselwörter

Patient-Behandler-­Beziehung - Patient-Behandler-­Kommunikation - Kommunikationspräferenzen - Patientenorientierung - Onkologie

Key words

patient-physician relationship - patient-physician communication - communication preferences - patient participation - oncology
 

  • Literatur

  • 1 Rodin G, Mackay J, Zimmermann C et al. Clinician-patient communication: a systematic review. Support Care Cancer 2009; 17: 627-644
    CrossrefPubMedGoogle Scholar
  • 2 Baile WF, Aaron J. Patient-physician communication in oncology: past, present, and future. Curr Opin Oncol 2005; 17: 331-335
    CrossrefPubMedGoogle Scholar
  • 3 Coyle N, Sculco L. Communication and the patient/physician relationship: a phenomenological inquiry. Support Oncol 2003; 1: 206-215
    PubMedGoogle Scholar
  • 4 Thorne SE, Hislop TG, Armstrong EA et al. Cancer care communication: The power to harm and the power to heal?. Patient Educ Couns 2008; 71: 34-40
    CrossrefPubMedGoogle Scholar
  • 5 Venetis MK, Robinson JD, Turkiewicz KL et al. An evidence base for patient-centered cancer care: A meta-analysis of studies of observed communication between cancer specialists and their patients. Patient Educ Couns 2009; 77: 379-383
    CrossrefPubMedGoogle Scholar
  • 6 Fox SA, Heritage J, Stockdale SE et al. Cancer screening adherence: Does physician-patient communication matter?. Patient Educ Couns 2009; 75: 178-184
    CrossrefPubMedGoogle Scholar
  • 7 Carcaise-Edinboro PP. Bradley CJ. Influence of patient-provider communication on colorectal cancer screening. Med Care 2008; 46: 738-745
    CrossrefPubMedGoogle Scholar
  • 8 Neumann M, Wirtz M, Bollschweiler E et al. Determinants and patient-reported long-term outcomes of physician empathy in oncology: A structural equation modelling approach. Patient Educ Couns 2007; 69: 63-75
    CrossrefPubMedGoogle Scholar
  • 9 Farin E, Nagl M. The patient-physician relationship in patients with breast cancer: descriptive results and influence on quality of life after rehabilitation. Qual Life Res. 2013 22. 283-294
    PubMedGoogle Scholar
  • 10 Thorne SE, Bultz BD, Baile WF. SCRN Communication Team. Is there a cost to poor communication in cancer care?: a critical review of the literature. Psychooncology 2005; 14: 875-884
    CrossrefPubMedGoogle Scholar
  • 11 Fujimori M, Uchitomi Y. Preferences of cancer patients regarding communication of bad news: A systematic literature review. Jpn J Clin Oncol 2009; 39: 201-216
    CrossrefPubMedGoogle Scholar
  • 12 Franssen SJ, Lagarde SM, van Werven JR et al. Psychological factors and preferences for communicating prognosis in esophageal cancer patients. Psychooncology 2009; 18: 1199-1207
    CrossrefPubMedGoogle Scholar
  • 13 Okuyama T, Endo C, Seto T et al. Cancer patients’ reluctance to disclose their emotional distress to their physicians: a study of Japanese pa­tients with lung cancer. Psychooncology 2008; 17: 460-465
    CrossrefPubMedGoogle Scholar
  • 14 Janz NK, Wren PA, Copeland LA et al. Patient-physician concordance: Preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol 2004; 22: 3091-3098
    CrossrefPubMedGoogle Scholar
  • 15 Feldman-Stewart D, Brennenstuhl S, Brundage MD et al. Overall information needs of early-stage prostate cancer patients over a decade: highly variable and remarkably stable. Support Care Cancer 2009; 17: 429-435
    CrossrefPubMedGoogle Scholar
  • 16 Squiers L, Finney Rutten LJ, Treiman K et al. Cancer patients’ informa­tion needs across the cancer care continuum: evidence from the cancer information service. J Health Commun 2005; 10 (Suppl. 01) 15-34
    CrossrefPubMedGoogle Scholar
  • 17 Carlson LE, Feldmann-Stewart B, Tishelman C et al. SCRN Communication Team. Patient-professional communication research in cancer: an integrative review of research methods in the context of a conceptual framework. Psychooncology 2005; 14: 812-828
    CrossrefPubMedGoogle Scholar
  • 18 Krupat E. Patient-physician fit: an idea whose time has come. Med Decis Making 2006; 26: 110-111
    CrossrefPubMedGoogle Scholar
  • 19 Jahng KH, Martin LR, Golin CE et al. Preferences for medical collaboration: patient-physician congruence and patient outcomes. Patient Educ Couns 2005; 57: 308-314
    CrossrefPubMedGoogle Scholar
  • 20 Cvengros JA, Christensen AJ, Cunningham C et al. Patient preference for and reports of provider behavior: Impact of symmetry on patient outcomes. Health Psychol. 2009. 28. 660-667
    Google Scholar
  • 21 Fujimori M, Parker PA, Akechi T et al. Japanese cancer patients’ communication style preferences when receiving bad news. Psychooncology 2007; 16: 617-625
    CrossrefPubMedGoogle Scholar
  • 22 Garfield S, Smith F, Francis SA et al. Can patients’ preferences for involvement in decision-making regarding the use of medicines be predicted?. Patient Educ Couns 2007; 66: 361-367
    CrossrefPubMedGoogle Scholar
  • 23 Fujimori M, Akechi T, Morita T et al. Preferences of cancer patients regarding the disclosure of bad news. Psychooncology 2007; 16: 573-581
    CrossrefPubMedGoogle Scholar
  • 24 Farin E, Gramm L, Kosiol D. Development of a questionnaire to assess communication preferences of patients with chronic illness. Patient Educ Couns 2011; 82: 81-88
    CrossrefPubMedGoogle Scholar
  • 25 Arora NK. Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci Med 2003; 57: 791-806
    CrossrefPubMedGoogle Scholar
  • 26 McCormack LA, Treiman K, Rupert D et al. Measuring patient-centered communication in cancer care: A literature review and the development of a systematic approach. Soc Sci Med 2011; 72: 1085-1095
    CrossrefPubMedGoogle Scholar
  • 27 Ouwens Ml, Hermens R, Hulscher M et al. Development of indicators for patient-centred cancer care. Support Care Cancer 2010; 18: 121-130
    CrossrefPubMedGoogle Scholar
  • 28 Degner LF, Sloan JA. Decision making during serious illness: What role do patients really want to play?. J Clini Epidemiol 1992; 45: 941-950
    PubMedGoogle Scholar
  • 29 Ende J, Kazis L, Ash A et al. Measuring patients’ desire for autonomy: decison making and information-seeking preferences among medical patients. J Gen Intern Med 1989; 4: 23-30
    CrossrefPubMedGoogle Scholar
  • 30 Bensing JMP, Dronkers J. Instrumental and affective aspects of physician behavior. Med Care 1992; 30: 283-298
    CrossrefPubMedGoogle Scholar
  • 31 Parker PA, Baile WF, de Moor C et al. Breaking news about cancer: patients’ preferences for communication. J Clin Oncol 2001; 19: 2049-2056
    CrossrefPubMedGoogle Scholar
  • 32 Kopec JA, Willison KD. A comparative review of four preference-weighted measures of health-related quality of life. J Clin Epidemiol 2003; 56: 317-325
    CrossrefPubMedGoogle Scholar
  • 33 Hahn EA, Rao D, Cella D et al. Comparability of interview- and self-administration of the Functional Assessment of Cancer Therapy-General (FACT-G) in english- and spanish-speaking ambulatory cancer patients. Med Care 2008; 46: 423-431
    CrossrefPubMedGoogle Scholar
  • 34 AMOS 16.0 AMOS Development Corporation; Crawfordville FL:
  • 35 Hu LT, Bentler P. Cutoff criteria for fit indices in covariance structure analysis: conventional criteria versus new alternatives. Structural Equ Modeling 1999; 6: 1-55
    PubMedGoogle Scholar
  • 36 Tucker L, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika 1973; 38: 1-10
    CrossrefPubMedGoogle Scholar
  • 37 Bond TG, Fox CM. Applying the Rasch model: Fundamental measurement in the human sciences. Lawrence Erlbaum Associates; Mahwah NJ: 2001
    Google Scholar
  • 38 Nunnally JC, Bernstein IRA. Psychometric theory. McGraw-Hill; 3 ed. New York: 1994
    Google Scholar
  • 39 Raudenbush SW, Bryk AS. Hierarchical linear models. Applications and data analysis methods. 2nd ed. Sage; Thousand Oaks CA: 2002
    Google Scholar
  • 40 Gramm L, Kosiol D, Opitz U et al. Qualitative Erfassung von Patientenpräferenzen und Behandlereinstellungen zur Patient-Behandler-Kommunikation: eine Fokusgruppen-Studie. Z Med Psychol 2011; 20: 76-87
    PubMedGoogle Scholar
  • 41 Hack TF, Degner LF, Parker PA. The communication goals and needs of cancer patients: a review. Psychooncolog 2005; 14: 831-845
    PubMedGoogle Scholar
  • 42 Leydon GM. ‘Yours is potentially serious but most of these are cured’: optimistic communication in UK outpatient oncology consultations. Psychooncology 2008; 17: 1081-1088
    CrossrefPubMedGoogle Scholar
  • 43 Matthias MS, Parpart AL, Nyland KA et al. The patient-provider rela­tionship in chronic pain care: Providers’ perspectives. Pain Med 2010; 11: 1688-1697
    CrossrefPubMedGoogle Scholar
  • 44 Surbone A. Telling the truth to patients with cancer: what is the truth?. Lancet Oncol 2006; 7: 944-950
    CrossrefPubMedGoogle Scholar
  • 45 Stewart DE, Wong F, Cheung AM et al. Information needs and decisional preferences among women with ovarian cancer. Gynecol Oncol 2000; 77: 357-361
    CrossrefPubMedGoogle Scholar
  • 46 Coulter A. Patient information and shared decision-making in cancer care. Br J Cancer 2003; 89: S15-S16
    PubMedGoogle Scholar
  • 47 Sawicki P. Qualität der Gesundheitsversorgung in Deutschland. Ein randomisierter simultaner Sechs-Länder-Vergleich aus Patientensicht. Medizinische Klinik – Intensivmedizin und Notfallmedizin 2005; 100: 755-768
    PubMedGoogle Scholar
  • 48 Schofield PE, Beeney LJ, Thompson JF et al. Hearing the bad news of a cancer diagnosis: The Australian melanoma patient’s perspective. Ann Oncol 2001; 12: 365-371
    CrossrefPubMedGoogle Scholar
  • 49 Chiu LQ, Lee WSD, Gao F et al. Cancer patients’ preferences for communication of unfavourable news: an Asian perspective. Support Care Cancer 2006; 14: 818-824
    CrossrefPubMedGoogle Scholar
  • 50 Lagarde S, Franssen S, van Werven J et al. Patient preferences for the disclosure of prognosis after esophagectomy for cancer with curative intent. Ann Surg Oncol 2008; 15: 3289-3298
    CrossrefPubMedGoogle Scholar
  • 51 Zenger M, Brix C, Borowski J et al. The impact of optimism on anxiety, depression and quality of life in urogenital cancer patients. Psychooncology 2010; 19: 879-886
    PubMedGoogle Scholar
  • 52 Farin E, Gramm L, Schmidt E. The patient-physician relationship in patients with chronic low back pain as a predictor of outcomes after rehabilitation. J Behav Med 2013; 36: 246-258
    CrossrefPubMedGoogle Scholar
  • 53 Meropol NJ, Egleston BL, Buzaglo JS et al. Cancer patient preferences for quality and length of life. Cancer 2008; 113: 3459-3466
    CrossrefPubMedGoogle Scholar
  • 54 Tsuchiya M, Horn SA. An exploration of unmet information needs among breast cancer patients in Japan: a qualitative study. Eur J Cancer Care 2009; 18: 149-155
    CrossrefPubMedGoogle Scholar
  • 55 Beaver K, Bogg J, Luker KA. Decision-making role preferences and information needs: a comparison of colorectal and breast cancer. Health Expect 1999; 2: 266-276
    CrossrefPubMedGoogle Scholar
  • 56 Hagerty RG, Butow PN, Ellis PM et al. Communicating prognosis in cancer care: a systematic review of the literature. Ann Oncol 2005; 16: 1005-1053
    CrossrefPubMedGoogle Scholar
  • 57 Siminoff LA, Graham GC, Gordon NH. Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors. Patient Educ Couns 2006; 62: 355-360
    CrossrefPubMedGoogle Scholar