How patients perceive a doctor's caring attitude
How patients perceive a doctor's caring attitude
复制标题
DOI：
10.1016/j.pec.2008.05.022
复制
发表时间：
2008-09-01
影响因子：
3.5
通讯作者：
Hatem, David
中科院分区：
文献类型：
--
作者：
Quirk, Mark;Mazor, Kathleen;Hatem, David
目的：护理与减少医疗事故诉讼、坚持治疗甚至症状缓解密切相关。关怀也包含在绩效薪酬公式中，并广泛用于质量改进目的。我们在这项前瞻性定性研究中的目标是定义与三种具有挑战性的遭遇相关的护理行为：讨论从治疗到姑息治疗的过渡、传递坏消息（癌症）以及讨论医疗错误（错误的测试结果）。目的是为创建“以患者为中心”的护理态度清单奠定基础，帮助医疗保健提供者理解并最终增强患者的护理体验。方法：随机选择一组非专业人士（以下称为患者）：（1）进行“大声思考”练习，帮助创建包含 15 项的护理行为清单； (2) 使用检查表对 20 名初级保健医生进行的模拟挑战性遭遇的录像进行评分（总共 600 个评分集）； (3) 参加 12 个单独的 1.5 小时焦点小组，讨论评分最高和最低的遭遇的录像带中表现出的关心（和不关心）行为。结果：13 种行为成为描述医生关心态度的焦点，但对于这些行为的具体例子是“关心”还是“不关心”存在分歧。例如，虽然移情询问的概念被大多数患者认为很重要，但医生的问题“你可以打电话或与某人交谈吗”（关于癌症诊断）被一名患者解释为“非常关心”，而另一名患者则对这种说法的表现“印象深刻”。结论：在概念层面上，有一组代表关心的行为，然而，这些行为的表现是“情人眼里出西施！”护理最重要的要素可能不是一系列行为，而是一系列潜在能力，包括站在患者的角度并反思患者的反应。实践意义：医学教育必须关注护理的潜在能力。 (C) 2008 Elsevier Ireland Ltd. 保留所有权利。
Objective: Caring is closely associated with reduced malpractice litigation, adherence to treatment and even symptom relief. Caring also is included in pay for performance formulas as well as widely utilized for quality improvement purposes. Our objective in this prospective qualitative study was to define caring behaviors associated with three challenging encounters: discussing the transition from curative to palliative care, delivering bad news (cancer), and discussing a medical error (misplaced test result). The purpose was to lay the groundwork for the creation of a 'patient-centered' caring attitude checklist that could help the healthcare provider understand and ultimately enhance the patient's experience of care.Methods: Groups of randomly selected lay people, henceforth referred to as patients: (1) engaged in 'think aloud' exercises to help create a 15-item caring behavior checklist; (2) used the checklist to rate videotapes of simulated challenging encounters conducted by twenty primary care physicians (total of 600 ratings sets); and (3) participated in 12 separate 1.5 h focus groups discussing the caring (and non-caring) behaviors exhibited in videotapes of the highest and lowest rated encounters.Results: Thirteen behaviors emerged as focal for describing a doctor's caring attitude but with disagreement as to whether specific examples of these behaviors were 'caring' or 'uncaring.' For example, although the concept of empathic inquiry was considered important by most patients, the physician question, "Is there someone you can call or talk with" (about a cancer diagnosis) was interpreted by one patient as 'very caring' while-another was 'impressed with how uncaring' the statement appeared.Conclusion: At the conceptual level there is a set of behaviors that represent caring, however, the manifestation of these behaviors is 'in the eye of the beholder! The most important element of caring may not be the set of behaviors but a set of underlying abilities that include taking the patient's perspective and reflecting on the patient's responses.Practice implications: Medical education must focus on the underlying abilities of caring. (C) 2008 Elsevier Ireland Ltd. All rights reserved.