'They Don't Ask Me So I Don't Tell Them': Patient-Clinician Communication About Traditional, Complementary, and Alternative Medicine
'They Don't Ask Me So I Don't Tell Them': Patient-Clinician Communication About Traditional, Complementary, and Alternative Medicine
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DOI：
10.1370/afm.947
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发表时间：
2009-03-01
影响因子：
4.4
通讯作者：
Crabtree, Benjamin. F.
中科院分区：
文献类型：
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作者：
Shelley, Brian M.;Sussman, Andrew L.;Crabtree, Benjamin. F.
虽然传统医学和补充替代医学（TM/CAM）的使用率很高，但对影响患者与其初级保健临床医生之间关于TM/CAM的沟通的因素关注较少。这种沟通可以是重要的，在预期可能的药物，草药的相互作用，并在保证协议的治疗plannes.METHODS，我们采用了顺序，多阶段，定性的方法，包括焦点小组，深入访谈，和视频小插曲，探讨TM/CAM患者和他们的初级保健临床医生之间的沟通。这项研究是在RIOS网（研究参与门诊设置网络），美国西南部的实践为基础的研究网络，主要位于西班牙裔和美国印第安人社区，TM/CAM是一个重要组成部分的self-care.RESULTS一百一十四例患者，41诊所工作人员，和19个初级保健临床医生在8个诊所网站参加。TM/CAM通信的程度和性质取决于临床遇到的某些条件。我们将这些发现分为3个主题：接受/不判断，沟通的开始和安全性/有效性。临床医生对TM/CAM的接受程度和讨论的开始强烈影响患者的沟通决定;临床医生在TM/CAM方面的专业知识不太重要。临床医生的舒适度与患者的自我护理方法和他们的关注程度缺乏科学证据的有效性和安全性的TM/CAM影响他们的沟通TM/CAM与patient.CONCLUSIONS具体的沟通障碍限制患者-临床医生沟通TM/CAM。希望与患者就这些主题进行更有效沟通并更好地整合患者使用的护理类型的临床医生可以通过旨在克服这些障碍的简单策略来改变沟通动态。
PURPOSE Although high rates of traditional medicine and complementary and alternative medicine (TM/CAM) use have been well documented, there has been less attention to the factors influencing communication between patients and their primary care clinicians about TM/CAM. Such communication can be important in anticipating possible drug-herb interactions and in assuring agreement about therapeutic plans.METHODS We used sequential, multistage, qualitative methods, including focus groups, in-depth interviews, and a video vignette, to explore communication about TM/CAM between patients and their primary care clinicians. The study was conducted in RIOS Net (Research Involved in Outpatient Settings Network), a Southwestern US practice-based research network, situated largely in Hispanic and American Indian communities where TM/CAM is an important part of self-care.RESULTS One hundred fourteen patients, 41 clinic staff members, and 19 primary care clinicians in 8 clinic sites participated. The degree and nature of TM/CAM communication is based on certain conditions in the clinical encounter. We categorized these findings into 3 themes: acceptance/nonjudgment, initiation of communication, and safety/efficacy. Perceived clinician receptivity to and initiation of discussion about TM/CAM strongly influenced patients' decisions to communicate; perceived clinician expertise in TM/CAM was less important. Clinicians' comfort with patients' self-care approaches and their level of concern about lack of scientific evidence of effectiveness and safety of TM/CAM influenced their communication about TM/CAM with patients.CONCLUSIONS Specific communication barriers limit patient-clinician communication about TM/CAM. Clinicians who wish to communicate more effectively with their patients about these topics and better integrate the types of care their patients use can change the communication dynamic with simple strategies designed to overcome these barriers.