Communicating with Patients with Disability: Perspectives of Practicing Physicians
Communicating with Patients with Disability: Perspectives of Practicing Physicians
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DOI：
10.1007/s11606-019-04911-0
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发表时间：
2019-07-01
影响因子：
5.7
通讯作者：
Iezzoni, Lisa I.
中科院分区：
文献类型：
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作者：
Agaronnik, Nicole;Campbell, Eric G.;Iezzoni, Lisa I.
背景技术背景：以病人为中心的护理残疾人需要有效的沟通和遵守美国残疾人法案（ADA）的目的：了解医生的观点与残疾人的沟通经验。设计：20个半结构化的个人访谈。访谈录音被逐字转录用于分析。地点：马萨诸塞州，2017年10月-2018年1月。参与者：20名医生，在初级保健或其他4个专业领域的实践从8到51年不等。测量与残疾人沟通的常见主题。结果：关注点集中在4大类：与聋人或听力障碍者的沟通经验、与盲人或视力障碍者的沟通、与智障者的沟通，以及改善沟通的建议。尽管本研究的参与者报告了与听力或视力丧失或智力残疾患者进行有效沟通的各种努力，但似乎仍然存在许多差距，以及医生的偏好与患者的愿望和ADA背道而驰的情况。例如，尽管患者希望现场口译员，但医生仍然偏好远程在线手语口译员，并建议患者安排自己的口译员。几乎没有盲文的教育材料，电子医疗记录可能不允许为视力低下的人打印大字体的文件。与智力残疾的患者沟通提出了特别的问题，与参与者往往更喜欢与照顾者和最小的努力参与patient.CONCLUSIONS：有效的沟通是必要的，以确保残疾人的医疗保健质量，它是根据ADA的法律要求。我们的研究结果表明，在确保有效的沟通方面可能仍然存在重要的差距，一些执业医生可以从与残疾患者沟通的有效方法的正式培训中受益。
BACKGROUND: Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA).OBJECTIVE: To understand physicians' perspectives on communication experiences with people with disability.DESIGN: Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis.SETTING: Massachusetts, October 2017-January 2018.PARTICIPANTS: Twenty physicians ranging from 8 to 51 years in practice in primary care or 4 other specialties.MeasurementsCommonly expressed themes around communication with people with disability.RESULTS: Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients.CONCLUSIONS: Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.