Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic.
Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic.
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DOI：
10.1186/s12882-018-0981-7
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发表时间：
2018-07-19
期刊：
影响因子：
2.3
通讯作者：
Bowling CB
中科院分区：
文献类型：
--
作者：
Vandenberg AE;Echt KV;Johnson TM 2nd;Bowling CB
了解慢性肾病（CKD）患者如何谈论他们与提供者的接触（即，他们的话语）可以告知让患者参与其慢性病自我管理的重要临床目标。本研究的目的是分析患者话语正在进行的慢性肾脏病监测遇到健康沟通策略，激励患者参与。从亚特兰大退伍军人事务部肾脏诊所的6份关于自我管理的焦点小组成绩单中提取了关于CKD监测的段落，共有30名年龄≥ 70岁的参与者，跨越三种不同的CKD轨迹（稳定、线性下降和非线性）。这些段落使用三阶段批评性话语分析（描述，解释，解释）进行检查，以确定各组之间的重复模式。焦点小组参与者平均年龄为75.1岁，96.7%为男性，60%为黑人。与CKD监测相关的传代（n = 55）主要产生负面沟通主题。感知到的负面沟通的特点是通过患者话语的不平等交换，从而参与患者将提供体液和时间的约会，并继续等待有意义的，语境化的监测信息从供应商和/或脱离供应商谁隐瞒该信息。然而，有些遭遇被描述为有益的。感知到的积极沟通的特点是患者话语的肾脏保护，使患者和供应商合作的共同目标，保护肾功能。患者认为CKD监测中的不平等交换。这种看法的根源似乎是缺乏容易理解的信息。通过访问保护肾脏的积极话语（例如，通过eGFR水平）与损害的论述（例如，血清肌酐水平），医疗保健专业人员可以阐明监测的目的，并以激励患者参与自我管理的方式。接受CKD进展监测的患者最好通过将监测概念化为肾脏保护并在每次监测时提供具体背景信息的消息传递来获得支持。
Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. Passages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups. Focus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function. Patient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter.
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影响因子：
2.3
作者：
Lederer S;Fischer MJ;Gordon HS;Wadhwa A;Popli S;Gordon EJ
通讯作者：
Gordon EJ
影响因子：
2.3
作者：
Thorne, S
通讯作者：
Thorne, S
影响因子：
3.5
作者：
Gordon, Howard S.;Pugach, Oksana;Ford, Marvella E.
通讯作者：
Ford, Marvella E.
影响因子：
2.9
作者：
Curtin, Roberta Braun;Walters, Brian A. J.;Klicko, Kristi
通讯作者：
Klicko, Kristi
DOI：
10.2215/cjn.06850616
发表时间：
2017-04-01
影响因子：
9.8
作者：
Bowling, C. Barrett;Vandenberg, Ann E.;Echt, Katharina V.
通讯作者：
Echt, Katharina V.