Decision or no decision: how do patient-physician interactions end and what matters?
Decision or no decision: how do patient-physician interactions end and what matters?
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决定或不决定：医患互动如何结束以及什么最重要？
DOI：
10.1007/s11606-006-0086-z
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发表时间：
2007-03
影响因子：
5.7
通讯作者：
Bao, Xiaoming
中科院分区：
文献类型：
--
作者：
Tai-Seale, Ming;Bromson, Rachel;Bao, Xiaoming
一个明确的临床决策可以诱导患者的认知关闭，是一个重要的投资，在病人和医生的沟通结束。关于在初级保健访问中做出明确决定的频率知之甚少。使用一种创新的录像带分析方法来评估医生的倾向，明确的状态决定，并检查影响决策模式的因素。我们对395盘初级保健访问录像带中讨论的主题进行了编码，注意到每个主题的讨论次数和长度，以及讨论如何结束。回归分析测试了明确的决定和访问因素之间的关系，如讨论的主题的性质，讨论的实例，病人说话的时间量，以及来自其他主题的竞争需求。大约77%的主题以明确的决定结束。患者平均每个主题发言58秒。患者在以明确决定结束的话题中发言更多（67秒），而在其他情况下为36秒。一个主题的实例数量与做出明确决定的可能性较高相关（OR = 1.73，p < 0.01）。访问中讨论的主题数量增加（OR = 0.95，p <0.05），生活方式和习惯主题（OR = 0.60，p <0.01）与明确决策的可能性较低相关。虽然讨论往往以明确的决定结束，但在互动的内容和动态方面存在差异。我们建议加强患者的声音和开发临床工具，例如，改善决策的“退出处方”。
A clearly stated clinical decision can induce a cognitive closure in patients and is an important investment in the end of patient–physician communications. Little is known about how often explicit decisions are made in primary care visits. To use an innovative videotape analysis approach to assess physicians’ propensity to state decisions explicitly, and to examine the factors influencing decision patterns. We coded topics discussed in 395 videotapes of primary care visits, noting the number of instances and the length of discussions on each topic, and how discussions ended. A regression analysis tested the relationship between explicit decisions and visit factors such as the nature of topics under discussion, instances of discussion, the amount of time the patient spoke, and competing demands from other topics. About 77% of topics ended with explicit decisions. Patients spoke for an average of 58 seconds total per topic. Patients spoke more during topics that ended with an explicit decision, (67 seconds), compared with 36 seconds otherwise. The number of instances of a topic was associated with higher odds of having an explicit decision (OR = 1.73, p < 0.01). Increases in the number of topics discussed in visits (OR = 0.95, p < .05), and topics on lifestyle and habits (OR = 0.60, p < .01) were associated with lower odds of explicit decisions. Although discussions often ended with explicit decisions, there were variations related to the content and dynamics of interactions. We recommend strengthening patients’ voice and developing clinical tools, e.g., an “exit prescription,” to improving decision making.
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影响因子：
120.7
作者：
Braddock, CH;Edwards, KA;Levinson, W
通讯作者：
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影响因子：
7
作者：
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7.2
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120.7
作者：
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3.1
作者：
Kraemer, HC;Blasey, CM
通讯作者：
Blasey, CM