患者-医師間コミュニケーションにおけるEBMとNBM : Roter Interaction Analysis Systemを用いたアプローチ(第47回日本心身医学会総会シンポジウム関連資料論文)  [in Japanese] Evidence Based Medicine and Narrative Based Medicine in Patient-Physician Communication : an Approach Using Roter Interaction Analysis System  [in Japanese]

患者-医師間のコミュニケーションは,診察の主要な構成要素であり,患者-医師関係を築き治療を進めるうえで必要な情報の共有や意思決定をしていくための,最も基本的な手段である.診察における医師,患者のコミュニケーションは,各個人の特性によって異なるだけでなく,その場での相手のコミュニケーション行動に影響を受け,それに対応して変化していく.したがって患者-医師間のコミュニケーションを分析するためには,患者-医師間の会話や行動を客観的に評価すると同時にその相互作用を明らかにする必要がある.Roterが開発した相互作用分析システムは,医療現場に特有な相互作用を評価できるツールである.本稿では,そのシステムを日本の外来癌診療場面に用いた研究を紹介し,患者-医師コミュニケーション研究の新たな可能性について展望する.

Communication between patient and physician has received special attention as a major component of medical encounters and a key to patient satisfaction and adherence. Various concepts and models developed in western countries have been introduced to Japan, including informed consent, decision-making, patient autonomy and patient-centered care. However, many aspects of social and cultural life relevant to patient-physician relationships differ between Western and Asian countries. Still, there have been few Japanese studies assessing the patient-physician communication quantitatively, although several qualitative studies focused on the interpretation of patient's narratives. Thus it is important to study the patient-physician communication using a standardized method in Japan. The purpose of this study is to describe characteristics of patient-physician communication in Japanese cancer consultations using the Roter Interaction Analysis System (RIAS), one of the most frequently used systems for the quantitative analysis of patient-physician communication, and to examine the relation of this communication with patient satisfaction. One hundred and forty cancer outpatients and twelve physicians were included. For our analysis, we combined the RIAS categories to make 12 clusters as follows; open-ended question, closed-ended question, information giving, direction, emotional expression (patient), emotional responsiveness (doctor), facilitation, positive talk, negative talk, orientation, requests for service, and social talk. Resultantly, a major part of the interaction concerned information-giving on both parts of physician and patient; this consisted of 35% and 34% of their communication, respectively. In contrast, some categories showed striking differences between physician and patient. The percentage of physicians' question-asking was almost double that of patients' for both open-ended and closed-ended questions, while patients made twice as many positive utterances as physicians. In summary, physicians made more utterances directing the interaction than patients did, and their discussion was largely focused on biomedical topics. The structure of the patient-physician interaction in our study was basically similar to those in previous western studies, although some differences were also found. The relation between patient-physician communication and patient satisfaction was generally consistent with previous studies. Patients were more satisfied with consultations in which the physician used more open-ended questions. On the other hand, physician direction and encouragement was negatively associated with patient satisfaction. Also, patients who asked more questions were less satisfied with the consultation. This study has suggested that the analysis using the RIAS might increase our understanding of the patient-physician interaction in Japan, though with a different perspective from the narrative approach, and provide a direction for future studies of patient-physician communication. In order to further explore the meaning and impact of the communication in the medical encounter and to find a way to improve it, qualitative and quantitative approaches should be used in combination based on study purposes.