Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study
Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study
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DOI：
10.1136/bmjqs-2019-009485
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发表时间：
2020-03-01
影响因子：
5.4
通讯作者：
Black, Georgia
中科院分区：
文献类型：
--
作者：
Amelung, Dorothee;Whitaker, Katriina L.;Black, Georgia
背景大多数癌症是在接触初级保健后诊断出来的。被诊断为癌症的患者在被转诊到专科医生那里之前，经常会因为潜在的相关症状多次就诊，目的了解医患之间围绕持续存在或新出现的问题的沟通的重要性及其对癌症及时诊断的潜在影响。研究设计基于医生和患者的视频记录的定性主题分析。初级保健中的病人咨询以及与病人和医生的后续访谈。80个视频观察，20个病人访谈和7个医生访谈，在7个一般的practices in England.Results我们发现，及时的诊断可能会受到不利影响，如果医生和病人不来的协议有关提出的问题的意义。“分歧”可能涉及认知失调的因素，如医生和患者之间的医学知识差异，或情绪失调的因素，如患者对诊断程序的未表达的恐惧。访谈表明，对话中的观点的差异，要么不承认或停留未解决可能会导致无益的患者行为咨询后（例如，不出席专家预约），创造潜在的诊断延迟和患者harm.Conclusions我们的研究结果突出了如何医患协商可以影响及时诊断时，患者存在持续或新的问题。未对准很常见，可能会被忽视，留下可能造成患者伤害的间隙。这些发现对癌症和其他严重疾病的及时诊断具有重要意义，因为它们突出了咨询的复杂性和流动性以及对诊断过程的后续影响。
Background Most cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations.Objective To understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis.Research design Qualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England.Results We found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem's significance. 'Disagreements' may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients' unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm.Conclusions Our findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.