Patient-centered communication during primary care visits for depressive symptoms: what is the role of physician personality?
Patient-centered communication during primary care visits for depressive symptoms: what is the role of physician personality?
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DOI：
10.1097/mlr.0b013e31817924e4
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发表时间：
2008-08
期刊：
影响因子：
3
通讯作者：
Kravitz RL
中科院分区：
文献类型：
--
作者：
Chapman BP;Duberstein PR;Epstein RM;Fiscella K;Kravitz RL
以患者为中心的沟通（PCC）与初级保健中更适当的抑郁症治疗相关。部分功能的病人介绍，鲜为人知的是其他影响PCC。我们调查了PCC是否也受到初级保健提供者（PCP）的个性倾向的影响，独立于患者的表现。46名PCP完成了NEO人格量表修订版中的人格量表，并为88名标准化患者（SP）提供了护理，这些患者患有重度抑郁症或适应障碍，伴有共病的肌肉骨骼症状，无论是否提出药物要求。编码器使用以患者为中心的沟通的测量对每次访问进行评分，评估医生探索患者的疾病经历（组件1），了解患者的心理社会背景（组件2）以及让患者参与治疗的协作讨论（组件3）的能力。调整医生的人口统计学，培训和病人的介绍，医生谁是更开放的感情探索病人的疾病经验更多（p = 0.05）。更尽职尽责或受规则约束的医生更多地探索患者的心理社会和生活环境（p = 0.04），但患者较少参与治疗讨论（p = 0.03），医生报告更多的焦虑脆弱性（p = 0.03）。医生人口统计学、培训和患者表现解释了MPCC组分中4-7%的方差，个性解释了另外4-7%的方差。了解促进或减损PCC的个性倾向，可以帮助医学教育工作者更好地识别不同能力的学员，以量身定制的方式解决个人培训需求。
Patient Centered Communication (PCC) is associated with more appropriate treatment of depression in primary care. In part a function of patient presentation, little is known about other influences on PCC. We investigated whether PCC was also influenced by personality dispositions of primary care providers (PCPs), independent of patient presentation. 46 PCPs completed personality scales from the NEO-Personality Inventory, Revised and provided care to 88 Standardized Patients (SPs) presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the Measure of Patient Centered Communication, assessing physicians’ ability to explore the patient’s illness experience (component 1), understand the patient’s psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3). Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patient’s experience of illness more (p = .05). More dutiful, or rule-bound physicians engaged in greater exploration of the patient’s psychosocial and life circumstances (p = .04), but involved the patient less in treatment discussions (p = .03), as did physicians reporting more anxious vulnerability (p = .03). Physician demographics, training, and patient presentation explained 4-7% of variance in MPCC components, with personality explaining an additional 4-7% of the variance. Understanding of personality dispositions which promote or detract from PCC may help medical educators better identify trainees of varying aptitude, addressing individual training needs in a tailored fashion.