The ecology of patient and caregiver participation in consultations involving advanced cancer.
The ecology of patient and caregiver participation in consultations involving advanced cancer.
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DOI：
10.1002/pon.4710
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发表时间：
2018-06
期刊：
影响因子：
3.6
通讯作者：
Epstein RM
中科院分区：
文献类型：
--
作者：
Freytag J;Street RL Jr;Xing G;Duberstein PR;Fiscella K;Tancredi DJ;Fenton JJ;Kravitz RL;Epstein RM
确定晚期癌症患者参与与肿瘤学家临床接触的预测因素，并评估患者和护理人员参与对医生支持感知的影响。这是来自癌症护理研究的价值和选择的辅助数据分析，这是一项以患者为中心的沟通干预的随机临床试验。患者和护理人员完成了访前和访后的健康和沟通措施。录音记录的患者-护理者（在场时）-医生接触被编码为积极的患者/护理者参与行为（例如，提问，表达关注）和医生的促进性沟通（例如，建立伙伴关系，支持）。混合线性回归模型用于识别患者、医生和情景因素，预测患者和患者与护理人员的沟通行为和访后结果。医生合作关系的建立预示着更多的关注和更自信的反应从病人和病人-护理者对表达。患者认为与医生的联系更紧密，这预示着患者表达的担忧会更少。在有护理人员陪同的患者中，患者对医生尊重其自主权的看法较低。护理人员对医生尊重患者自主权的看法随着患者年龄的增加而下降，并因地点而异。在晚期癌症治疗中，患者和护理者的沟通在他们的咨询中受到生态因素的影响。医生可以通过促进沟通，如建立伙伴关系和支持性谈话，支持患者更多地参与临床接触。护理人员的存在使这种环境变得复杂，但建立伙伴关系的技术可能有助于促进患者和护理人员在这些访问中的参与。
To identify predictors of participation of patients with advanced cancer in clinical encounters with oncologists and to assess the impact of patient and caregiver participation on perceptions of physician support. This is a secondary data analysis from the Values and Options in Cancer Care study, a cluster randomized clinical trial of a patient-centered communication intervention. Patients and caregivers completed pre-visit and post-visit health and communication measures. Audio recorded patient-caregiver (when present)-physician encounters were coded for active patient/caregiver participation behaviors (eg, question asking, expressing concern) and for physicians’ facilitative communication (eg, partnership-building, support). Mixed linear regression models were used to identify patient, physician, and situational factors predicting patient and patient plus caregiver communication behaviors and post-visit outcomes. Physician partnership building predicted greater expressions of concern and more assertive responses from patients and patient-caregiver pairs. Patients’ perceptions of greater connectedness with their physician predicted fewer patient expressions of concern. Patient perceptions of physician respect for their autonomy were lower among patients accompanied by caregivers. Caregiver perceptions of physician respect for patient autonomy decreased with increasing patient age and varied by site. In advanced cancer care, patient and caregiver communication is affected by ecological factors within their consultations. Physicians can support greater patient participation in clinical encounters through facilitative communication such as partnership-building and supportive talk. The presence of a caregiver complicates this environment, but partnership building techniques may help promote patient and caregiver participation during these visits.
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影响因子：
28.4
作者：
Epstein RM;Duberstein PR;Fenton JJ;Fiscella K;Hoerger M;Tancredi DJ;Xing G;Gramling R;Mohile S;Franks P;Kaesberg P;Plumb S;Cipri CS;Street RL Jr;Shields CG;Back AL;Butow P;Walczak A;Tattersall M;Venuti A;Sullivan P;Robinson M;Hoh B;Lewis L;Kravitz RL
通讯作者：
Kravitz RL
影响因子：
3.6
作者：
Street, Richard L.;Gordon, Howard S.
通讯作者：
Gordon, Howard S.
影响因子：
4.4
作者：
Epstein, Ronald M.;Street, Richard L., Jr.
通讯作者：
Street, Richard L., Jr.
影响因子：
--
作者：
ROTER, DL;HALL, JA;ROCA, RP
通讯作者：
ROCA, RP
影响因子：
3.8
作者：
Hoerger, Michael;Epstein, Ronald M.;Kravitz, Richard L.
通讯作者：
Kravitz, Richard L.