Analyzing patient participation in medical encounters
Analyzing patient participation in medical encounters
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DOI：
10.1207/s15327027hc1301_06
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发表时间：
2001-01-01
影响因子：
3.9
通讯作者：
Millay, B
中科院分区：
文献类型：
--
作者：
Street, RL;Millay, B
提供保健的一个基本组成部分是病人与保健提供者之间的协商。参与医疗咨询基本上是一个沟通事件，临床医生和患者使用谈话来交换信息，分享他们的专业知识和观点，建立信任关系，并做出与健康相关的决定。越来越多的证据表明，更积极地参与这些接触的患者对他们的医疗保健更满意，接受更多以患者为中心的护理（例如，信息，支持），更致力于治疗方案，对健康有更强的控制感，甚至在就诊后比被动的患者更健康（综述见Kaplan，格林菲尔德，& Ware，1989; Roter & Hall，1993; Street，2001）。由于患者参与是医疗保健过程的重要组成部分，因此调查人员必须使用具有坚实概念基础的可靠有效措施来分析这一现象。首先，我们描述的概念基础和测量策略，在我们的方法来分析的沟通行为，构成病人参与医疗遭遇。其次，我们应用我们的方法来分析九个录像记录的医生与病人的互动。将检查两个研究问题（RQ）：（a）患者在与医生互动时提出问题、表达担忧和采取自信行为的程度如何？和（B）当他们的医生使用伙伴关系建立时，患者是否是更积极的沟通者（例如，征求患者的意见）和支持性谈话（例如，鼓励、鼓励）。最后，我们结束了讨论的挑战和发展更生态有效和有效的程序，评估病人参与护理的前景。
An essential component of the delivery of health care is the consultation between the patient and health care provider. Participation in the medical consultation is fundamentally a communicative event in which clinicians and patients use talk to exchange information, to share their expertise and points of view, to build a trusting relationship, and to make health-related decisions. A growing body of evidence indicates that patients who more actively participate in these encounters are more satisfied with their health care, receive more patient-centered care (e.g., information, support) from providers, are more committed to treatment regimens, have a stronger sense of control over health, and even experience better health following the visit than do more passive patients (for reviews, see Kaplan, Greenfield, & Ware, 1989; Roter & Hall, 1993; Street, 2001). Because patient involvement is an important part of the health care process, it is imperative that investigators analyze the phenomenon using reliable and valid measures that have a solid conceptual foundation.In this article, we have three objectives. First, we describe the conceptual foundation and measurement strategies used in our approach to analyzing the communicative acts that constitute patient participation in medical encounters. Second, we apply our method to an analysis of nine videotaped recordings of physician-patient interactions. Two research questions (RQs) will be examined: (a) To what extent do patients ask questions, express concerns, and engage in assertive behavior in their interactions with physicians? and (b) Are patients more active communicators when their physicians use partnership building (e.g., soliciting the patient's opinion) and supportive talk (e.g., reassurance, encouragement)? Finally, we conclude with a discussion of challenges and prospects for developing more ecologically valid and efficient procedures for assessing patient participation in care.