의료 의사소통의 필수적 요소: The Kalamazoo Consensus Statement

의료에서 의사소통의 필수적 요소: The Kalamazoo Consensus Statement

Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement

Participants in the Bayer–Fetzer Conference on Physician–Patient Communication in Medical Education

의료와 의학교육에 있어서 의사-환자 커뮤니케이션이 점차 강조되고 있고, 이는 international consensus statements, guideline for medical schools, standards for professional practice and education에서 잘 나타난다.

A growing emphasis on physician—patient communication in medicine and medical education is reflected in international consensus statements,1,2 guidelines for medical schools,3–6 and standards for professional practice and education.7–12

본 연구는 open-ended, iterative process로 진행되었다.

The group used an open-ended, iterative process to identify and prioritize topics for discussion.

의사-환자 의사소통의 다섯 가지 모델을 활용하였다.

Since the group included architects and representatives of five currently used models of doctor—patient communication, participants agreed that the goals might best be achieved through review and synthesis of the models' essential elements. Toward that end, brief presentations were delivered about each of the five models:

• * Bayer Institute for Health Care Communication E4 Model 18
•  18. Keller V, Carroll JG. A new model for physician—patient communication. Patient Educ Couns. 1994;23:131–40. 

• * Three Function Model/Brown Interview Checklist 19
• 19. Novack DH, Dube C, Goldstein MG. Teaching medical interviewing: a basic course on interviewing and the physician—patient relationship. Arch Intern Med. 1992;152:1814–20. 

• * The Calgary—Cambridge Observation Guide 20
• 20. Kurtz S, Silverman J, Draper J. Teaching and Learning Communication Skills in Medicine. Abingdon, Oxon, U.K.: Radcliffe Medical Press, 1998. 

• * Patient-centered clinical method 21
• 21. Stewart M, Belle Brown J, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage, 1995. 

• * SEGUE Framework for teaching and assessing communication skills 22
• 22. Makoul G. Communication research in medical education. In: Jackson L, Duffy BK (eds). Health Communication Research: A Guide to Developments and Directions. Westport, CT: Greenwood Press, 1998:17–35. 

필수 요소

THE ESSENTIAL ELEMENTS

 

의사-환자 커뮤니케이션의 필수 요소에 대한 합의에 도달하였다. 본 연구에 참여한 그룹의 '필수 요소'에 대한 관점은 task approach와 일치하였는데, 이는 1980년대 초반부터 커뮤니케이션 교육에 있어서 많은 지지를 받던 것이었다. Makoul와 Schofield가 주장한 것처럼 "task에 초점을 두는 것은 커뮤니케이션 기술을 배우는 목적이 무엇인지를 알게 한다. 또한 task 접근법은 학습자 개개인의 특성에 맞춘 전략과 기술 레파토리를 개발할 수 있게 도와주며, 환자에 대해서 유연하게 대처하도록 도와준다."

Consensus on the essential elements of physician—patient communication was reached by using the three goals outlined above to guide and ground discussion. The group's perspective on essential elements is consistent with the task approach, a concept that has been well supported in communication skills teaching since the early 1980s.3,18–25 As noted by Makoul and Schofield,2 “focusing on tasks provides a sense of purpose for learning communication skills. The task approach also preserves the individuality of [learners] by encouraging them to develop a repertoire of strategies and skills, and respond to patients in a flexible way.”

관계 쌓기: 의사소통의 토대

Build a Relationship: The Fundamental Communication Task

 

A strong, therapeutic, and effective relationship is the sine qua non of physician—patient communication.29,30 The group endorses a patient-centered, or relationship-centered, approach to care, which emphasizes both the patient's disease and his or her illness experience.31,32 

• This requires eliciting the patient's story of illness while guiding the interview through a process of diagnostic reasoning. 
• It also requires an awareness that the ideas, feelings, and values of both the patient and the physician influence the relationship.2,15,33 
• Further, this approach regards the physician—patient relationship as a partnership, and respects patients' active participation in decision making.34–36 
• he task of building a relationship is also relevant for work with patients' families and support networks. 

In essence, building a relationship is an ongoing task within and across encounters: it undergirds the more sequentially ordered sets of tasks identified below.

 

대화 열기

Open the Discussion 

* Allow the patient to complete his or her opening statement

* Elicit the patient's full set of concerns 

* Establish/maintain a personal connection

 

정보 수집하기

Gather Information 

* Use open-ended and closed-ended questions appropriately 

* Structure, clarify, and summarize information 

* Actively listen using nonverbal (e.g., eye contact) and verbal (e.g., words of encouragement) techniques

 

환자의 관점 이해하기

Understand the Patient's Perspective 

* Explore contextual factors (e.g., family, culture, gender, age, socioeconomic status, spirituality) 

* Explore beliefs, concerns, and expectations about health and illness 

* Acknowledge and respond to the patient's ideas, feelings, and values

 

정보 공유하기

Share Information 

* Use language the patient can understand 

* Check for understanding 

* Encourage questions

 

문제와 계획에 대해 동의 구하기

Reach Agreement on Problems and Plans 

* Encourage the patient to participate in decisions to the extent he or she desires 

* Check the patient's willingness and ability to follow the plan 

* Identify and enlist resources and supports

 

마무리하기

Provide Closure 

* Ask whether the patient has other issues or concerns 

* Summarize and affirm agreement with the plan of action 

* Discuss follow-up (e.g., next visit, plan for unexpected outcomes)

CONCLUSION

 

This outline of essential elements in effective physician—patient communication provides a coherent framework for teaching and assessing communication skills, determining relevant knowledge and attitudes, and evaluating educational programs. In addition, the outline can inform the development of specific standards in this domain.

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Acad Med. 2001 Apr;76(4):390-3.

Essential elements of communication in medical encounters: the Kalamazoo consensus statement.

Makoul G.

Abstract

In May 1999, 21 leaders and representatives from major medical education and professional organizations attended an invitational conference jointly sponsored by the Bayer Institute for Health Care Communication and the Fetzer INSTITUTE: The participants focused on delineating a coherent set of essential elements in physician-patient communication to: (1) facilitate the development, implementation, and evaluation of communication-oriented curricula in medical education and (2) inform the development of specific standards in this domain. Since the group included architects and representatives of five currently used models of doctor-patient communication, participants agreed that the goals might best be achieved through review and synthesis of the models. Presentations about the five models encompassed their research base, overarching views of the medical encounter, and current applications. All attendees participated in discussion of the models and common elements. Written proceedings generated during the conference were posted on an electronic listserv for review and comment by the entire group. A three-person writing committee synthesized suggestions, resolved questions, and posted a succession of drafts on a listserv. The current document was circulated to the entire group for final approval before it was submitted for publication. The group identified seven essential sets of communication tasks: (1) build the doctor-patient relationship; (2) open the discussion; (3) gather information; (4) understand the patient's perspective; (5) share information; (6) reach agreement on problems and plans; and (7) provide closure. These broadly supported elements provide a useful framework for communication-oriented curricula and standards.

PMID:

 

11299158

 

[PubMed - indexed for MEDLINE]