Starting the conversation: Patient initiation of weight-related behavioral counseling during pregnancy.
Starting the conversation: Patient initiation of weight-related behavioral counseling during pregnancy.
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DOI：
10.1016/j.pec.2016.05.002
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发表时间：
2016-10
影响因子：
3.5
通讯作者：
Roter DL
中科院分区：
文献类型：
--
作者：
Washington Cole KO;Roter DL
探讨怀孕期间病人接受体重相关行为辅导与其主动性的关系。我们检查了22名产科医生和120名患者之间的产前访问的录音行为咨询使用Roter互动分析系统和5A的行为咨询框架。我们使用多变量回归模型来研究患者初始化和沟通结果之间的关系。总体而言，55%的产前检查包括任何行为咨询。患者开始咨询事件的45.5%，这些访问。在产前访视中，患者在患者发起的行为咨询事件中较少受到临床医生的口头主导（临床医生口头主导比差异= 0.73，95%CI = 0.16-1.30）。患者发起的咨询事件包括更多的社会情感沟通相对于那些由临床医生（p = 0.02）。咨询的总持续时间长28秒（95%CI 0.27-56.0秒），当患者开始讨论时，临床医生更可能使用两种或多种5A策略（OR = 3.61，95%CI = 1.01-12.88）。患者启动可能会导致行为咨询，持续时间更长，包括更多的5A的策略，可能介导的社会情感沟通。产前保健的沟通可能会导致更有效的咨询，是对妇女的关注。
To examine the relationship between patient initiation and weight-related behavioral counseling during pregnancy. We examined audio recordings of prenatal visits between 22 obstetricians and 120 patients for behavioral counseling using the Roter Interaction Analysis System and the 5A’s behavioral counseling framework. We used multivariate regression models to examine the relationship between patient initiation and communication outcomes. Overall, 55% of prenatal visits included any behavioral counseling. Patients initiated counseling episodes 45.5% of these visits. Patients were less verbally dominated by their clinicians in prenatal visits with patient-initiated behavioral counseling episodes (difference in clinician verbal dominance ratio = 0.73, 95% CI = 0.16–1.30). Patient-initiated counseling episodes included more socioemotional communication relative to those initiated by clinicians (p = 0.02). The total duration of counseling was 28 seconds longer (95% CI 0.27–56.0 seconds) and clinicians were more likely to use two or more 5A’s strategies (OR = 3.61, 95% CI = 1.01–12.88) when patients initiated discussions. Patient initiation may lead to behavioral counseling that is longer in duration and includes more 5A’s strategies, possibly mediated by socioemotional communication. Participatory prenatal care communication may lead to more effective counseling that is responsive to women’s concerns.
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