Skip to main content

Advertisement

Log in

Patientenorientierte Kommunikation in der Arzt-Patient-Beziehung

Patient-centered communication in the physician–patient relationship

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Im Zuge der Forderung nach mehr Patientenorientierung im deutschen Gesundheitswesen sieht sich auch die Arzt-Patient-Kommunikation einem Wandlungsprozess ausgesetzt. Stärker als früher sind Ärzte aufgefordert, die kommunikativen Bedürfnisse ihrer Patienten nach Information, Mitwirkung bei medizinischen Entscheidungen und emotionaler Unterstützung zu berücksichtigen. Ein partnerschaftliches Modell der Arzt-Patient-Beziehung erscheint als am besten geeignet, diese Bedürfnisse zu befriedigen und die Betroffenen in die Lage zu versetzen (Empowerment), informierte Entscheidungen über ihre Gesundheitsversorgung zu treffen (partizipative Entscheidungsfindung). Allerdings zeigt eine breite Evidenzlage, wie sie insbesondere für Gespräche zwischen Krebskranken und ihren Ärzten vorliegt, dass die Bedürfnisse der Patienten noch nicht ausreichend thematisiert und befriedigt werden. Das hier bestehende Optimierungspotenzial ist umso ernster zu nehmen, als eine Orientierung der Arzt-Patient-Kommunikation an den Bedürfnissen der Betroffenen nicht nur deren Zufriedenheit, Lebensqualität und Wohlbefinden fördert, sondern wohl auch mit besseren medizinischen Behandlungsergebnissen einhergeht.

Abstract

As a result of increasing demands for more patient-centeredness in the German health care system, physician–patient communication has been subject to transformation. Physicians are being requested to take into account their patients’ communicative needs, including information, shared decision making, and emotional support, more vigorously than they had been in the past. A cooperative model of the physician–patient relationship is considered most suitable for fulfilling these needs and for empowering patients to make informed decisions regarding their own health care. However, a large body of evidence exists—particularly regarding communication between cancer patients and their doctors—that shows that patients’ needs are not adequately addressed or met. This potential for optimization is all the more important because targeting patients’ needs during doctor–patient communication not only improves patients’ satisfaction with the communication, quality of life, and well-being, but may also produce better treatment outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Robert Koch-Institut (Hrsg) (2006) Bürger- und Patientenorientierung im Gesundheitswesen. Robert Koch-Institut, Berlin

  2. Watzlawick P (2007) Menschliche Kommunikation. Formen, Störungen, Paradoxien, 11. Aufl. Huber, Bern

  3. Schulz von Thun F (2005) Miteinander reden. Störungen und Klärungen. Rowohlt, Hamburg

  4. Farin E (2010) Die Patient-Behandler-Kommunikation bei chronischen Krankheiten: Überblick über den Forschungsstand in ausgewählten Themenbereichen. Rehabilitation 49:277–291

    Article  PubMed  CAS  Google Scholar 

  5. Little P, Everitt H, Williamson I et al (2001) Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. Br Med J 323:908–911

    Article  CAS  Google Scholar 

  6. Neumann M, Bensing J, Mercer SW et al (2009) Analyzing the „nature“ and „specific effectiveness“ of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns 74:339–346

    Article  PubMed  Google Scholar 

  7. Zandbelt LC, Smets EMA, Oort FJ et al (2007) Patient participation in the medical specialist encounter: Does physicians‘ patient-centred communication matter? Patient Educ Couns 65:396–406

    Article  PubMed  Google Scholar 

  8. Levinson W, Roter D, Mullooly JP et al (1997) Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA 277:553–559

    Article  PubMed  CAS  Google Scholar 

  9. Ambady N, LaPlante D, Nguyen T et al (2002) Surgeons‘ tone of voice: a clue to malpractice history. Surgery 132:5–9

    Article  PubMed  Google Scholar 

  10. Faller H, Weis J (2005) Bedarf und Akzeptanz psychosozialer Versorgung. In: Faller H (Hrsg) Psychotherapie bei somatischen Erkrankungen. Thieme, Stuttgart, S 18–31

  11. O’Leary KA, Estabrooks CA, Olson K, Cumming C (2007) Information acquisition for women facing surgical treatment for breast cancer: influencing factors and selected outcomes. Patient Educ Couns 69:5–19

    Article  Google Scholar 

  12. Butow PN, Brown RF, Cogar S, Tattersall MHN et al (2002) Oncologists‘ reactions to cancer patients‘ verbal cues. Psychooncology 11:47–58

    Article  PubMed  CAS  Google Scholar 

  13. Härter M, Loh A, Spies C (Hrsg) (2005) Gemeinsam entscheiden – erfolgreich behandeln. Deutscher Ärzte Verlag, Köln

  14. Gattellari M, Voigt KJ, Butow PN, Tattersall MHN (2002) When the treatment goal is not cure: Are cancer patients equipped to make informed decisions? J Clin Oncol 20:503–513

    Article  PubMed  Google Scholar 

  15. Bilodeau B, Degner LF (1996) Information needs, sources of information, and decisional roles in woman with breast cancer. Oncol Nurs Forum 23:691–696

    PubMed  CAS  Google Scholar 

  16. Coulter A (1997) Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res Policy 2:112–121

    PubMed  CAS  Google Scholar 

  17. Ong LML, Haes JCJM de, Hoos AM, Lammes FB (1995) Doctor-patient communication: a review of the literature. Soc Sci Med 40:903–918

    Article  PubMed  CAS  Google Scholar 

  18. Loh A, Simon D, Kriston L, Härter M (2007) Patientenbeteiligung bei medizinischen Entscheidungen. Dtsch Ärztebl 104:A1483–1488

    Google Scholar 

  19. Stewart M, Brown JB, Donner A et al (2000) The impact of patient-centered care on outcomes. J Fam Pract 49:796–804

    PubMed  CAS  Google Scholar 

  20. Dibbelt S, Schaidhammer M, Fleischer C, Greitemann B (2010) Patient-Arzt-Interaktion in der Rehabilitation: Gibt es einen Zusammenhang zwischen wahrgenommener Interaktionsqualität und langfristigen Behandlungsergebnissen? Rehabilitation 49:315–325

    Article  PubMed  CAS  Google Scholar 

  21. Emanuel EJ, Emanuel LL (1992) Four models of the physician-patient relationship. JAMA 267:2221–2226

    Article  PubMed  CAS  Google Scholar 

  22. Charavel M, Bremond A, Moumjid-Ferdjaoui N et al (2001) Shared decision-making in question. Psychooncology 10:93–102

    Article  PubMed  CAS  Google Scholar 

  23. Towle A, Godolphin W (1999) Framework for teaching and learning informed shared decision making. Br Med J 319:766–771

    Article  CAS  Google Scholar 

  24. Roter DL, Stewart M, Putnam SM et al (1997) Communication patterns of primary care physicians. JAMA 277:350–356

    Article  PubMed  CAS  Google Scholar 

  25. Charles C, Gafni A, Whelan T (1997) Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med 44:681–692

    Article  PubMed  CAS  Google Scholar 

  26. Aujoulat I, d’Hoore W, Deccache A (2007) Patient empowerment in theory and practice: polysemy or cacophonie? Patient Educ Couns 66:13–20

    Article  PubMed  Google Scholar 

  27. Say RE, Thomson R (2003) The importance of patient preferences in treatment decisions – challenge for doctors. Br Med J 327:542–545

    Article  Google Scholar 

  28. Montgomery AA, Fahey T (2001) How do patients‘ treatment preferences compare with those of clinicians? Qual Health Care 10:39–43

    Article  Google Scholar 

  29. Holmström I, Röing M (2010) The relation between patient-centeredness and patient empowerment: a discussion on concepts. Patient Educ Couns 79:167–172

    Article  PubMed  Google Scholar 

  30. Anderson RM, Funnell MM (2005) Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Couns 57:153–157

    Article  PubMed  Google Scholar 

  31. Tengland PA (2008) Empowerment: a conceptual discussion. Health Care Anal 16:77–96

    Article  PubMed  Google Scholar 

  32. Faller H, Reusch A, Meng K (2011) DGRW-Update: Patientenschulung. Rehabilitation 50:284–291

    Article  PubMed  CAS  Google Scholar 

  33. Faller H, Reusch A, Meng K (2011) Innovative Schulungskonzepte in der medizinischen Rehabilitation. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 54:444–450

    Article  CAS  Google Scholar 

  34. Stewart M, Brown JB, Weston WW et al (2006) Patient-centered medicine, 2. Aufl. Radcliffe, Abingdon

  35. Keating NL, Guadagnoli E, Landrum MB et al (2002) Treatment decision making in early-stage breast cancer: Should surgeons match patients‘ desired level of involvement? J Clin Oncol 20:1473–1479

    Article  PubMed  Google Scholar 

  36. Liang W, Burnet CB, Rowland J et al (2002) Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol 20:1008–1016

    Article  PubMed  Google Scholar 

  37. Vogel BA, Helmes AW, Bengel J (2006) Arzt-Patienten-Kommunikation in der Tumorbehandlung: Erwartungen und Erfahrungen aus Patientensicht. Z Med Psychol 15:149–161

    Google Scholar 

  38. Lehmann C, Koch U, Mehnert A (2009) Die Bedeutung der Arzt-Patient-Kommunikation für die psychische Belastung und die Inanspruchnahme von Unterstützungsangeboten bei Krebspatienten. Psychother Psych Med 59:253–263

    Article  Google Scholar 

  39. Hack TF, Degner LF, Parker PA (2005) The communication goals and needs of cancer patients: a review. Psychooncology 14:831–845

    Article  PubMed  Google Scholar 

  40. Kerr J, Engel J, Schlesinger-Raab A et al (2003) Communication, quality of life and age: results of a 5-year prospective study in breast cancer patients. Ann Oncol 14:421–427

    Article  PubMed  CAS  Google Scholar 

  41. Kleeberg UR, Tews J-T, Ruprecht T et al (2005) Patient satisfaction and quality of life in cancer outpatients: results of the PASQOC study. Support Care Cancer 13:303–310

    Article  PubMed  CAS  Google Scholar 

  42. Vogel BA, Bengel J, Helmes AW (2008) Information and decision making: patients‘ needs and experiences in the course of breast cancer treatment. Patient Educ Couns 71:79–85

    Article  PubMed  Google Scholar 

  43. Vogel BA, Leonhart R, Helmes AW (2009) Communications matters: the impact of communication and participation in decision making on breast cancer patients‘ depression and quality of life. Patient Educ Couns 77:391–397

    Article  PubMed  Google Scholar 

  44. Janz NK, Wren PA, Copeland LA et al (2004) Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol 22:3091–3098

    Article  PubMed  Google Scholar 

  45. Hawley ST, Lantz PM, Janz NK et al (2007) Factors associated with patient involvement in surgical treatment decision making for breast cancer. Patient Educ Couns 65:387–395

    Article  PubMed  Google Scholar 

  46. Kiesler DJ, Auerbach SM (2006) Optimal matches of patient preferences for information, decision-making and interpersonal behaviour: evidence, models and interventions. Patient Educ Couns 61:319–341

    Article  PubMed  Google Scholar 

  47. Hack TF, Degner LF, Watson P, Sinha L (2006) Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psychooncology 15:9–19

    Article  PubMed  Google Scholar 

  48. Andersen MR, Bowen DJ, Morea J et al (2009) Involvement in decision-making and breast cancer survivor quality of life. Health Psychol 28:29–37

    Article  PubMed  Google Scholar 

  49. Hack TF, Pickles T, Ruether D et al (2010) Predictors of distress and quality of life in patients undergoing cancer therapy: impact of treatment type and decisional role. Psychooncology 19:606–616

    PubMed  Google Scholar 

  50. Mandelblatt JD, Edge SB, Meropol NJ et al (2003) Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care. J Clin Oncol 21:855–863

    Article  PubMed  Google Scholar 

  51. Arora NK, Weaver KE, Clayman ML et al (2009) Physicians‘ decision-making style and psychosocial outcomes among cancer survivors. Patient Educ Couns 77:404–412

    Article  PubMed  Google Scholar 

  52. Sepucha K, Ozanne E, Silvia K et al (2007) An approach to measuring the quality of breast cancer decisions. Patient Educ Couns 65:261–269

    Article  PubMed  Google Scholar 

  53. Figueiredo MI, Cullen J, Hwang YT et al (2004) Breast cancer treatment in older women: Does getting what you want improve your long-term body image and mental health? J Clin Oncol 22:4002–4009

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H. Faller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Faller, H. Patientenorientierte Kommunikation in der Arzt-Patient-Beziehung. Bundesgesundheitsbl. 55, 1106–1112 (2012). https://doi.org/10.1007/s00103-012-1528-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00103-012-1528-x

Schlüsselwörter

Keywords

Navigation