人际传播视角下医患坏消息告知的“五维沟通”策略——基于“约哈里之窗”窗口移动规律的思考

A Five-Dimensional Communication Strategy Between Doctors and Patients for Notifying Bad News From the Perspective of Interpersonal Communication:Reflections on the Movement Pattern of the“Johari's Window”

“坏消息告知”是医患沟通中最具挑战性的情景,被国内外公认为医务人员沟通技能中最关键的内容之一。当前国内关于坏消息告知的研究中,大多从宏观视角研究医患坏消息告知态度、喜好或行为特征等话语外围要素,少有从微观视角关注坏消息告知如何具体展开。微观视角与人际传播特殊形式的特征密切相关,从人际传播视角解读医患坏消息沟通,基于人际传播的经典理论——“约哈里之窗”审视坏消息告知这一过程,并从“示善—询问—披露—倾听—引导”五个维度提出沟通策略。

Notifying bad news is the most challenging scenario in doctor-patient communication,and is recognized as one of the most critical elements of communication skills for medical personnel at home and abroad.In current domestic studies on this subject,most studies investigate the peripheral elements of the discourse such as doctor-patient bad news communication’s atti⁃tudes,preferences,or behavioral characteristics from a macro perspective,but few studies focus on the specific conversations be⁃tween doctors and patients in the process of informing bad news from a micro perspective.The micro perspective is closely relat⁃ed to the characteristics of a special form of interpersonal communication.This paper interpreted doctor-patient bad news com⁃munication from the perspective of interpersonal communication,examined the process of informing bad news based on the clas⁃sical theory of interpersonal communication—“Johari’s Window”,and proposed a communication strategy from the five dimen⁃sions of“showing kindness—asking—disclosing—listening—guiding”.