A Multicenter Study of Physician Mindfulness and Health Care Quality

作者：Beach Mary Catherine^*; Roter Debra; Korthuis P Todd; Epstein Ronald M; Sharp Victoria; Ratanawongsa Neda; Cohn Jonathon; Eggly Susan; Sankar Andrea; Moore Richard D; Saha Somnath

来源：Annals of Family Medicine, 2013, 11(5): 421-428.

DOI：10.1370/afm.1507

• patient-physician relations
• patient-physician communication
• mindfulness
• HIV
• acquired immunodeficiency syndrome

PURPOSE Mindfulness (ie, purposeful and nonjudgmental attentiveness to one%26apos;s own experience, thoughts, and feelings) is associated with physician well-being. We sought to assess whether clinician self-rated mindfulness is associated with the quality of patient care. %26lt;br%26gt;METHODS We conducted an observational study of 45 clinicians (34 physicians, 8 nurse practitioners, and 3 physician assistants) caring for patients infected with the human immunodeficiency virus (HIV) who completed the Mindful Attention Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites across the United States. We measured patient-clinician communication quality with audio-recorded encounters coded using the Roter Interaction Analysis System (RIAS) and patient ratings of care. %26lt;br%26gt;RESULTS In adjusted analyses comparing clinicians with highest and lowest tertile mindfulness scores, patient visits with high-mindfulness clinicians were more likely to be characterized by a patient-centered pattern of communication (adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58-10.86), in which both patients and clinicians engaged in more rapport building and discussion of psychosocial issues. Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted beta = 1.17; 95% CI, 0.46-1.9). Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio [APR] = 1.48; 95% CI, 1.17-1.86) and to report high overall satisfaction (APR = 1.45; 95 CI, 1.15-1.84) with high-mindfulness clinicians. There was no association between clinician mindfulness and the amount of conversation about biomedical issues. %26lt;br%26gt;CONCLUSIONS Clinicians rating themselves as more mindful engage in more patient-centered communication and have more satisfied patients. Interventions should determine whether improving clinician mindfulness can also improve patient health outcomes.

• 出版日期2013-10