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目的关于解释坏消息(breaking bad news,BBN)咨询与高应激水平和沟通不良的相关因素之前尚未做过研究。本研究确定了在完成BBN任务中与医生的应激反应和沟通不良最主要的相关因素。方法 2007年,笔者邀请了24名医生,包括12名新手(即有1～3年工作经历的实习/住院医生)和12名专家(即有4年余工作经历的注册内科/放射肿瘤或癌症外科医生)。这些医生作为被试者参加了模拟BBN咨询和许多控制任务。对所有被试者的5min心率,心率变化和完成沟通做了评估。被试者还完成了含有之前BBN经历、感知应激、心理应激(即焦虑、抑郁)、疲劳及职业倦怠的短式问卷。结果高应激反应与未经历过BBN、疲劳和相对于好消息传递坏消息相关。咨询中沟通不良与职业倦怠和疲劳高分相关。结论结果提示,即便是模拟BBN对医生来讲也是个应激经历,尤其是那些未经历过和(或)疲劳者。除了未经历过BBN,沟通不良还与职业倦怠和疲乏相关。这些结果似乎可提示,有些医生在模拟BBN任务时是因职业倦怠和疲劳产生了应激和完成任务不良。
Objectives No studies have been conducted before breaking bad news (BBN) counseling related to high stress levels and poor communication. This study identified the most important relevant factors for stress response and poor communication with physicians in completing the BBN task. Methods In 2007, the author invited 24 doctors, including 12 new recruits (that is, internships / residents with 1 to 3 years of working experience) and 12 experts (ie, registered medical / radiotherapy cancer or cancer with more than 4 years of working experience Surgeon). These doctors participated as participants in simulating BBN counseling and many control tasks. All subjects were assessed for 5min heart rate, heart rate changes and complete communication. Subjects also completed a short questionnaire that included previous BBN experiences, perceived stress, psychological stress (ie, anxiety, depression), fatigue, and burnout. Results High stress responses correlated with bad news without BBN, fatigue, and good news. Poor communication in counseling is associated with burnout and fatigue scores. Conclusions The results suggest that even simulated BBN is a stressful experience for physicians, especially those who have not experienced and / or are tired. In addition to not having experienced BBN, poor communication is associated with job burnout and fatigue. These results seem to suggest that some physicians are stressful and job-poor due to job burnout and fatigue in simulating BBN tasks.