Experience and Context Shape Patient and Clinician Goals For Treatment of Rheumatoid Arthritis: A Qualitative Study.
Experience and Context Shape Patient and Clinician Goals For Treatment of Rheumatoid Arthritis: A Qualitative Study.
复制标题
DOI：
10.1002/acr.23541
复制
发表时间：
2018-11
影响因子：
4.7
通讯作者：
Koenig CJ
中科院分区：
文献类型：
--
作者：
Barton JL;Hulen E;Schue A;Yelin EH;Ono SS;Tuepker A;Koenig CJ
患者和临床医生的目标一致，中央有效的以患者为中心的护理，已被链接到改善患者的经验和结果，但尚未在类风湿性关节炎（RA）的探索。本研究旨在探讨RA患者和临床医生的目标概念化。七个焦点小组和一个半结构化的采访进行了RA患者和临床医生从四个风湿病诊所招募。访谈指南的开发，以探索目标一致性相关的RA治疗。研究人员采用了并行演绎归纳数据分析方法。19名患者（平均年龄55岁; 74%女性; 32%非白人; 26%讲西班牙语）和18名临床医生（44%受训人员; 44%女性; 28%非白人）参与了研究。在临床医生和患者焦点组中，确定了两个领域：1）患者对RA的了解和2）RA治疗中的心理社会动力学（压力）。在知识领域内，出现了三个主题：1）知情选择的RA知识; 2）确保依从性和药物安全性的RA知识; 3）临床医生假设患者无法解释信息。在RA和压力的第二个领域中，出现了两个主题：1）患者的疾病经历以临床医生不共享的方式告知治疗背景; 2）患者-临床医生沟通和决策对目标一致性的影响。知识是一个共同的目标，但RA患者和临床医生对此目标持有不同的态度。虽然知识对于自我管理和有效的共同决策来说是不可或缺的，但态度的不匹配可能会导致沟通不佳。支持患者目标导向的RA护理的工具可以促进高质量的以患者为中心的护理，并减少差异。
Patient and clinician goal alignment, central to effective patient-centered care, has been linked to improved patient experience and outcomes, but has not been explored in rheumatoid arthritis (RA). This study aimed to explore goal conceptualization among RA patients and clinicians. Seven focus groups and one semi-structured interview were conducted with RA patients and clinicians recruited from four rheumatology clinics. An interview guide was developed to explore goal concordance related to RA treatment. Researchers utilized a concurrent deductive-inductive data analysis approach. 19 patients (mean age 55; 74% female; 32% nonwhite; 26% Spanish speakers) and 18 clinicians (44% trainees; 44% female; 28% nonwhite) participated. Across clinician and patient focus groups, two domains were identified: 1) patient knowledge of RA and 2) psychosocial dynamics (stress) in RA treatment. Within the knowledge domain, three themes emerged: 1) RA knowledge for informed choice; 2) RA knowledge to ensure adherence and medication safety; and 3) clinician assumption of patient inability to interpret information. Within the second domain of RA and stress, two themes emerged: 1) patient’s illness experience informs treatment context in ways not shared by clinicians; and 2) impact of patient-clinician communication and decision making on goal concordance. Knowledge is a shared goal, but RA patients and clinicians hold divergent attitudes towards this goal. While knowledge is integral to self-management and effective shared decision making, mismatch in attitudes may lead to suboptimal communication. Tools to support patient goal-directed RA care may promote high quality patient-centered care and result in reduced disparities.
登录
查看更多内容
影响因子：
2.9
作者：
Kuluski K;Gill A;Naganathan G;Upshur R;Jaakkimainen RL;Wodchis WP
通讯作者：
Wodchis WP
影响因子：
4.7
作者：
Barton, J. L.;Trupin, L.;Yelin, E.
通讯作者：
Yelin, E.
影响因子：
16.2
作者：
Bohlen, Krista;Scoville, Elizabeth;Montori, Victor M.
通讯作者：
Montori, Victor M.
DOI：
10.1080/15265161.2013.802060
发表时间：
2013
期刊：
The American journal of bioethics : AJOB
影响因子：
--
作者：
Entwistle VA;Watt IS
通讯作者：
Watt IS
影响因子：
27.4
作者：
Smolen JS;Breedveld FC;Burmester GR;Bykerk V;Dougados M;Emery P;Kvien TK;Navarro-Compán MV;Oliver S;Schoels M;Scholte-Voshaar M;Stamm T;Stoffer M;Takeuchi T;Aletaha D;Andreu JL;Aringer M;Bergman M;Betteridge N;Bijlsma H;Burkhardt H;Cardiel M;Combe B;Durez P;Fonseca JE;Gibofsky A;Gomez-Reino JJ;Graninger W;Hannonen P;Haraoui B;Kouloumas M;Landewe R;Martin-Mola E;Nash P;Ostergaard M;Östör A;Richards P;Sokka-Isler T;Thorne C;Tzioufas AG;van Vollenhoven R;de Wit M;van der Heijde D
通讯作者：
van der Heijde D