Problems and processes in medical encounters: the cases method of dialogue analysis.
Problems and processes in medical encounters: the cases method of dialogue analysis.
复制标题
医疗遭遇中的问题和过程：对话分析的案例法。
DOI：
10.1016/j.pec.2012.12.012
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发表时间：
2013
影响因子：
3.5
通讯作者：
Wilson,IraB
中科院分区：
文献类型：
--
作者：
Laws,MBarton;Taubin,Tatiana;Bezreh,Tanya;Lee,Yoojin;Beach,MaryCatherine;Wilson,IraB
ACTIVETo开发方法，可靠地捕捉结构和动态的时间特征的临床interactions.METHODSObservational研究的50个音频记录的常规门诊访问艾滋病毒专科诊所，使用创新的分析方法。相遇系统结构的综合分析（CASES）使用编码为言语行为的转录本，然后施加更大规模的结构元素：线程-解决的问题或问题;线程内的过程-临床护理的基本任务，标记为演示，信息，解决方案（决策）和参与（人际交流）。线索也被编码的性质的决议。61%的话语是在演示过程中。提供者的言语优势是最大的信息和决议的过程中，其中也包含了高比例的提供者指令。大约有一半的线程不会导致任何操作或决策。在陈述过程中，信息主要从患者流向提供者，在信息过程中，信息主要从提供者流向患者。Engagement is rare.CONCLUSIONSIn this data，resolution is provider centered;更多的时间让患者参与解决，或人际交往，将不得不来自presentation.Practice implicationsAwareness的使用时间在临床遭遇，和与各种任务相关的互动过程，可能有助于使临床沟通更高效和有效。
OBJECTIVETo develop methods to reliably capture structural and dynamic temporal features of clinical interactions.METHODSObservational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The Comprehensive Analysis of the Structure of Encounters System (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads – the problems or issues addressed; and processes within threads – basic tasks of clinical care labeled Presentation, Information, Resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution.RESULTS61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare.CONCLUSIONSIn this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation.Practice implicationsAwareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.