Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site
Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site
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DOI：
10.1080/13557858.2013.857762
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发表时间：
2015-01-02
影响因子：
3.1
通讯作者：
Lewis-Fernandez, Roberto
中科院分区：
文献类型：
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作者：
Aggarwal, Neil K.;Desilva, Ravi;Lewis-Fernandez, Roberto
目标.跨文化心理健康研究人员经常分析患者的疾病解释模型，以优化服务提供。文化形成访谈（Cultural Formation Interview，CFI）是一种跨文化评估工具，于2013年5月与DSM-5一起发布，以修订DSM-IV文化形成纲要（OCF）的不足之处。CFI现场试验在6个国家、14个研究中心和321名患者中进行，以探索其可行性、可接受性和患者和临床医生的临床效用。我们试图分析CFI的可行性、可接受性和临床实用性是否以及如何与患者-临床医生沟通相关。我们报告了来自纽约研究中心的数据，该研究中心招募了7名临床医生和32名患者，共32名患者-临床医生配对。我们进行了一项独立于母公司现场试验的数据分析，对所有参与者（n = 64）进行了内容分析，这些参与者基于来自医疗沟通和实施结果框架的代码簿。3名编码员分别创建编码本，独立编码，建立评分员间编码信度，并分析CFI是否影响医疗沟通的可行性、可接受性和临床实用性。尽管在我们的患者和临床医生群体中存在种族，民族，文化和专业差异，但我们发现，通过访谈，引发数据，引发患者的观点和多层次感知数据来提高满意度是解释CFI如何影响医疗沟通的常见代码。我们还发现，除了两个代码外，所有代码都属于临床实用性的实施结果，两个代码属于可接受性，没有一个代码属于可行性。我们的研究为文化访谈如何影响医患沟通的研究提供了新的方向。未来的研究可以分析CFI和其他文化访谈如何影响临床环境中的医疗沟通，以及对药物依从性，预约保留和健康状况等结果的后续影响。
Objectives. Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication.Design. We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n = 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility.Results. Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient's perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome of clinical utility, two fell under acceptability, and none fell under feasibility.Conclusion. Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition.