Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.
Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.
复制标题
转变医患关系以促进以患者为中心的护理：姑息治疗的经验教训。
DOI：
10.1016/j.jpainsymman.2006.06.007
复制
发表时间：
2007
影响因子：
4.7
通讯作者：
Yedidia,MichaelJ
中科院分区：
文献类型：
--
作者：
Yedidia,MichaelJ
姑息治疗是研究其潜力，以产生教训，转变医患关系，促进以病人为中心的护理。对从治愈性治疗到姑息性治疗过渡过程中患者和提供者的经验进行检查，有望对建立和维持信任作为护理转变的目标以及解决广泛的患者需求提供有价值的见解。该研究以现有模型为基础的概念框架为指导，以解决医患关系的五个维度：满足的需求范围、权威来源、信任的维护、情感参与和真实性的表达。资料收集包括观察40名在安宁疗护病房住院及在家的病人，访谈病人及家属，以及深入访谈22名提供临终关怀的医生及2名护士。使用标准的定性程序来分析数据，结合最大限度地提高结果有效性和扩大其与其他情况的相关性的技术。研究结果为挑战关于医患关系可能性的突出假设提供了证据：质疑禁止情感参与的优点，依赖协议来处理困难的沟通问题，无条件地依赖消费者授权来确保护理能够响应患者的需求，以及在医疗和社会服务系统之间采用狭窄的界限来照顾患者。医学教育可以通过公开处理日常临床工作中的情绪管理、纳入个人意识培训、通过使用标准化的病人和录像带促进对与病人的互动进行反思，以及通过团队合作培训扩大有效解决广泛需求的能力，从而使医生做好承担新角色的准备。
Palliative care was studied for its potential to yield lessons for transforming doctor-patient relationships to promote patient-centered care. Examination of patient and provider experiences of the transition from curative to palliative care promises valuable insights about establishing and maintaining trust as the goals of care shift and about addressing a broad spectrum of patient needs. The study was guided by a conceptual framework grounded in existing models to address five dimensions of doctor-patient relationships: range of needs addressed, source of authority, maintenance of trust, emotional involvement, and expression of authenticity. Data collection included observation of the care of 40 patients in the inpatient hospice unit and at home, interviews with patients and family members, and in-depth interviews with 22 physicians and two nurses providing end-of-life care. Standard qualitative procedures were used to analyze the data, incorporating techniques for maximizing the validity of the results and broadening their relevance to other contexts. Findings provide evidence for challenging prominent assumptions about possibilities for doctor-patient relationships: questioning the merits of the prohibition on emotional involvement, dependence on protocols for handling difficult communication issues, unqualified reliance on consumer empowerment to assure that care is responsive to patients' needs, and adoption of narrowly defined boundaries between medical and social service systems in caring for patients. Medical education can play a role in preparing doctors to assume new roles by openly addressing management of emotions in routine clinical work, incorporating personal awareness training, facilitating reflection on interactions with patients through use of standardized patients and videotapes, and expanding capacity to effectively address a broad range of needs through teamwork training.