Recognising the importance of 'family time-out' in consultations: an exploratory qualitative study.
Recognising the importance of 'family time-out' in consultations: an exploratory qualitative study.
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DOI：
10.1136/bmjopen-2012-002144
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发表时间：
2013-01-16
期刊：
影响因子：
2.9
通讯作者：
Campbell R
中科院分区：
文献类型：
--
作者：
Korfage IJ;Audrey S;Hak T;Blazeby JM;Abel J;Campbell R
患者在就诊期间通常有家人或同伴陪同，但人们对这可能如何影响整个过程知之甚少。我们探讨了咨询中同伴的存在如何有助于沟通和决策过程。观察性研究。英格兰西南部的一所教学医院和一所地区综合医院。在会诊过程中对 31 名患者及其医生进行了观察，并做出了接受姑息化疗的决定。每位患者至少有一名同伴陪同。医生、患者和同伴之间的沟通模式。除了标准的患者/医生互动之外，患者和同伴还经常在没有医生积极参与的情况下讨论医疗信息并交换意见。我们将这些情况称为“家庭暂停”。当患者和同伴对首选治疗方案存在分歧时，医生和患者能够在承认意见差异的同时达成一致决定。 “家庭暂停”的实例可能有助于更好的咨询结果，因为它们得到了患者社会系统的理解和支持。这项研究强调了患者和同伴在咨询期间交流的潜在重要作用，以及医生如何从观察这种交流中受益。我们建议测试在咨询过程中为家人提供休息空间的价值。此外，我们建议进一步研究家庭暂停的医学伦理学。虽然这里的重点是姑息化疗，但这一发现对其他咨询有影响，特别是那些涉及困难治疗决定的咨询。
Patients are often accompanied by family or companions during consultations, but little is known about how this might influence the process. We explored how the presence of a companion in a consultation contributes to communication and the decision-making process. Observational study. A teaching hospital and a district general hospital in south-west England. 31 patients and their physicians were observed during consultations in which decisions to undergo palliative chemotherapy were made. Each patient was accompanied by at least one companion. Communication patterns between physicians, patients and companions. In addition to standard patient/physician interactions, patients and companions were often found to discuss medical information and exchange opinions between themselves without the physician actively participating. We called these instances ‘family time-out’. On the occasion of disagreement between patients and companions about preferred treatment options, physicians and patients were able to agree the decision while acknowledging the differences in opinion. Instances of ‘family time-out’ may contribute to better consultation outcomes because they are understood and supported by the patient's social system. This study highlights the potentially important role of exchanges between patients and companions during consultations and how physicians may benefit from observation of such exchanges. We recommend testing the value of making space for family time-out during consultations. Also, we recommend further study into the medical ethics of family time-out. While the focus here is on palliative chemotherapy, this finding has implications for other consultations, particularly those involving difficult treatment decisions.
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