Die Patient-Behandler-Kommunikation bei chronischen Krankheiten: Überblick über den Forschungsstand in ausgewählten Themenbereichen

Zusammenfassung

Die Kommunikation zwischen Patienten und Behandlern ist insbesondere bei der Behandlung chronisch Kranker, die durch ein biopsychosoziales Krankheitsmodell charakterisiert ist, von zentraler Bedeutung. Der vorliegende Beitrag stellt im Rahmen einer Übersichtarbeit den aktuellen Forschungsstand zur Patient-Behandler-Kommunikation in 3 ausgewählten Themenbereichen dar: die Kommunikationspräferenzen chronisch Kranker, der Zusammenhang zwischen Kommunikation und relevanten Endpunkten sowie Interventionen zur Verbesserung der Patient-Behandler-Kommunikation. Ein zentrales Ergebnis der Forschung besteht darin, dass Patienten hinsichtlich der Präferenz bestimmter Kommunikationsstile (z. B. Patientenpartizipation) eine recht hohe inter- und intraindividuelle Variabilität zeigen; sie unterscheiden sich untereinander und entwickeln auch im Lauf ihrer Erkrankung variierende Präferenzen. Es lassen sich jedoch auch kommunikative Verhaltensweisen des Behandlers identifizieren, die in der Regel von sehr vielen Patienten als positiv empfunden werden: affektives Verhalten (also z. B. nach Gefühlen des Rehabilitanden fragen, diese Gefühle wahrnehmen und zurückmelden), Informationen in verständlicher Weise und proaktiv geben, Wahrnehmungen, Erwartungen und kognitive Konzepte des Patienten zu verstehen versuchen. Es ist in der Literatur gut belegt, dass gelungene Kommunikation zu mehr Adhärenz führt. Der Zusammenhang zur Patientenzufriedenheit ist nicht ganz so deutlich belegt, konnte aber auch oft gezeigt werden. Bezüglich der Verbesserung des Gesundheitsstatus des Patienten sind die Befunde uneinheitlich. Erfolgreiche Kommunikation setzt eine gewisse Kongruenz zwischen den Kommunikationspräferenzen des Patienten und den Verhaltensweisen des Behandlers voraus. Die Wirksamkeit von Kommunikationstrainings für Behandler ist im Hinblick auf das unmittelbare Geschehen in der Patient-Behandler-Interaktion (z. B. patientenorientierteres Verhalten) recht gut belegt; die Evidenz bezüglich mittelfristiger Endpunkte wie Patientenzufriedenheit ist uneinheitlich, was auch an der Vielzahl möglicher Operationalisierungen der Endpunkte liegt. Wichtig und sinnvoll scheint eine Ergänzung der Behandlertrainings durch kommunikationsbezogene Schulungen für Patienten, da verschiedene Studien zeigen, dass mit relativ einfachen Maßnahmen, die am Patienten ansetzen, auch das Verhalten der Behandler beeinflusst werden kann. Weiterentwicklungsbedarf der Forschung zur Patient-Behandler-Kommunikation besteht insbesondere bezüglich einer verstärkten theoretischen Fundierung, einer Methodenintegration unter Einschluss qualitativer und quantitativer Methoden sowie Selbstberichten und Interaktionsanalysen sowie bezüglich der verstärkten Durchführung von Längsschnittsstudien.

Abstract

Communication between patient and providers is extremely important, especially for the treatment of chronically ill patients, characterized by a biopsychosocial disease model. This article presents an overview of the current status of research on patient-provider communication in 3 selected areas: the communication preferences of chronically ill persons, the correlation between communication and relevant endpoints, and interventions to improve patient-provider communication. One major result of the research is that patients display a rather high degree of inter- and intra-individual variability with respect to the preference of certain communication styles (e. g. patient participation); there are differences among them, and they develop varying preferences in the course of their illness. However, communicative behavior of the provider that is generally perceived by many patients to be positive can also be identified: affective behavior (for example, asking the patient about his/her feelings, being sensitive to these feelings and responding to them), providing information in an understandable, proactive manner, and attempting to understand the patient's perceptions, expectations, and cognitive concepts. Successful communication requires a certain congruence between the patient's communication preferences and the provider's behavior. It has been sufficiently documented in literature that successful communication leads to greater adherence. The correlation to patient satisfaction is not documented quite as clearly but has often been shown. The findings vary with respect to the improvement in the patient's health status. The effectiveness of communication training for providers has been documented quite well regarding the immediate endpoints in patient-provider interaction (e. g., patient-oriented behavior); the evidence with respect to medium-term endpoints such as patient satisfaction varies, also due to the number of possible operationalizations of the endpoints. Supplementing provider training with communication-related training for patients appears to be an important and useful method as many studies have shown that the behavior of providers can be influenced using relatively simple measures that start with the patient. There is a need for further development of research on patient-provider communication, in particular with respect to a more solid theoretical basis, integration of methods including qualitative and quantitative methods, self-evaluations, and interaction analyses, and also concerning conducting more longitudinal studies.

Schlüsselwörter

Patient-Behandler-Kommunikation - Kommunikationspräferenzen - Kommunikationstrainings - Arzt-Patient-Beziehung

Key words

patient-provider communication - communication preferences - communication training - physician-patient relationship

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1 Im Singular wird die männliche, im Plural die weibliche Form genutzt. Es sind jeweils beide Geschlechter gemeint. Wenn ein bestimmtes Geschlecht angesprochen werden soll, so wird dies durch das Adjektiv „weiblich” oder „männlich” explizit hervorgehoben.

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