"Why Do They Need to Check Me?" Patient Participation Through eHealth and the Doctor-Patient Relationship: Qualitative Study
"Why Do They Need to Check Me?" Patient Participation Through eHealth and the Doctor-Patient Relationship: Qualitative Study
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“他们为什么要检查我？”“通过电子健康和医患关系的患者参与：定性研究
DOI：
10.2196/jmir.8444
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发表时间：
2018-01-01
影响因子：
7.4
通讯作者：
Rexhepi, Hanife
中科院分区：
文献类型：
--
作者：
Gruenloh, Christiane;Myreteg, Gunilla;Rexhepi, Hanife
背景：医患关系中的角色正在发生变化，患者在医疗保健中的参与越来越受到重视。已经实施了电子健康(EHealth)服务，如患者可访问的电子健康记录(PAEHR)，以支持患者参与。关于PAEHR的实际应用及其对医生和患者角色的影响，我们知之甚少。目的：这项定性研究旨在调查医生如何看待患者参与的理念，特别是与PAEHR系统的关系。因此，本文旨在更深入地了解医生的PAEHR结构、在医患关系中的角色以及参与的层次和范围。方法：对不同领域的医生进行了12次半结构式访谈。访谈被转录、翻译，并进行了理论上知情的主题分析。结果：确定了与医患关系相关的两个重要方面：角色和参与。医生们认为他们的角色是承担责任，决定治疗方案，并成为值得信任的人。关于患者的角色，缺乏技能(技术或关于医学术语)，阅读动机，以及患者的特征是在访谈中确定的方面。患者经常被称为静态实体，而不考虑他们随着时间的推移发展技能和知识的潜力。结论：至少二十年的文献表明，家长式的医疗保健方法是不合适的，应该采取与患者合作的过程。尽管参与这项研究的医生表示，他们原则上赞成患者参与，但分析发现，在他们对参与的日常实践的描述中，几乎没有支持参与的事实。从结果可以看出，家长式的做法仍然存在，即使专业人士可能没有意识到这一点。这可能会在努力变得更知情的患者和他们的问题之间造成冲突，这些问题被解读为对医生的批评和不信任的迹象。因此，我们认为PAEHR的潜力尚未充分发挥，并认为患者赋权的概念是有问题的，因为它引发了将卫生保健中的“权力”解释为零和游戏，这无助于维持行为者之间的关系。患者参与的讨论通常仅仅与决策有关；然而，这项研究强调了也需要包括感觉制造和学习活动。这将为患者提出问题提供另一种理解，不是在“监督医生”方面，而是在理解情况方面。
Background: Roles in the doctor-patient relationship are changing and patient participation in health care is increasingly emphasized. Electronic health (eHealth) services such as patient accessible electronic health records (PAEHRs) have been implemented to support patient participation. Little is known about practical use of PAEHR and its effect on roles of doctors and patients.Objective: This qualitative study aimed to investigate how physicians view the idea of patient participation, in particular in relation to the PAEHR system. Hereby, the paper aims to contribute to a deeper understanding of physicians' constructions of PAEHR, roles in the doctor-patient relationship, and levels and limits of involvement.Methods: A total of 12 semistructured interviews were conducted with physicians in different fields. Interviews were transcribed, translated, and a theoretically informed thematic analysis was performed.Results: Two important aspects were identified that are related to the doctor-patient relationship: roles and involvement. The physicians viewed their role as being the ones to take on the responsibility, determining treatment options, and to be someone who should be trusted. In relation to the patient's role, lack of skills (technical or regarding medical jargon), motives to read, and patients' characteristics were aspects identified in the interviews. Patients were often referred to as static entities disregarding their potential to develop skills and knowledge over time. Involvement captures aspects that support or hinder patients to take an active role in their care.Conclusions: Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted. Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized. As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician. We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of "power" in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors. Patient involvement is often discussed merely in relation to decision making; however, this study emphasizes the need to include also sensemaking and learning activities. This would provide an alternative understanding of patients asking questions, not in terms of "monitoring the doctor" but to make sense of the situation.