Die Ausbildung kommunikativer Fähigkeiten in der Medizin

 

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Zusammenfassung

Hintergrund: Der Wunsch von Patienten nach Aufklärung wird von den Ärzten westlicher Länder weitgehend anerkannt. Kurse zur Vorbereitung auf diese schwierige Aufgabe sind vor allem im angloamerikanischen Raum Bestandteil der medizinischen Ausbildung. Die Übersichtsarbeit referiert und diskutiert die bisherigen Evaluationsergebnisse. Methoden: Die Literatursuche erfolgte mit Hilfe der Datenbank PUBMED unter Verwendung der Stichworte „breaking bad news” und „bad news”. Berücksichtigt wurden zwischen 1. 1. 1960 bis 31. 12. 2000 publizierte Artikel, die empirische Daten eigener Kursevaluationen enthalten. Ergebnisse: Alle 16 analysierten Kurse verwenden praktische Unterrichtsmethoden zur Bearbeitung des Themas. Die Evaluation der Kursmethoden und der Selbsteinschätzung kommunikativer Fähigkeiten ist mehrheitlich positiv. Gespräche mit Simulationspatienten zeigen Veränderungen der Gesprächsführung nach dem Kommunikationstraining. Schlussfolgerungen: Bei den Teilnehmern besteht eine hohe Akzeptanz bezüglich der Methoden und Inhalte von Kursen zum Thema „schlechte Nachrichten mitteilen”. Die Erarbeitung theoretisch und empirisch begründeter Empfehlungen für die Durchführung von Diagnosegesprächen ist Aufgabe zukünftiger Studien. Forschungsbedarf besteht weiterhin bei der Auswirkung von Kommunikationstraining auf die Krankheitsbewältigung von Patienten in der Praxis.

Abstract

Background: Patients rights regarding information about their illness are accepted by the vast majority of doctors in the western world. Breaking bad news have become a part of medical education. This review summarizes and discusses the finding of studies containing empirical data of course evaluations. Methods: Sources were obtained through PUBMED using „breaking bad news” and „bad news” as key words. Relevant to this paper are studies which were published between 1. 1. 1960 - 31. 12. 2000 and include empirical data of evaluations of breaking bad news courses. Results: All 16 studies use practical methods as the main course methods. Positive results regarding the evaluation of methods, content and self perception of own communication skills are reported by the majority of the studies. Eight studies using simulated patients report improved communication skills. Conclusions: Breaking bad news courses are rated very positive and do have an effect on the communication skills of the participants. However, there is a need of empirical and theoretical work regarding the most effective strategies. Further studies should be carried out to evaluate the effects of communication skills training regarding the health and adjustment of patients.

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Prof. Dr. med. Dr. phil. Jochen Vollmann

Institut für Geschichte und Ethik der Medizin · Friedrich-Alexander-Universität Erlangen-Nürnberg

Glückstraße 10

91054 Erlangen

Email: jochen.vollmann@gesch.med.uni-erlangen.de