Rethinking Doctor-Patient Relationships

重新思考医患关系

• 批准号: 6761940
• 负责人: Michael Joel Yedidia
• 金额: $ 19.76万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-08-01 至 2006-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6761940
• 关键词: alternative medicine; behavioral /social science research tag; chronic disease /disorder; clinical research; curriculum; education evaluation /planning; extended care; health care model; health care quality; health services research tag; human subject; interview; medical education; model design /development; patient care; patient care personnel relations; self help

DESCRIPTION: (Provided by the Applicant) Transformation of provider-patient relationships will be essential to the success of efforts to achieve patient-centered care, as envisioned in the IOM report, Crossing the Quality Chasm. This research will investigate new ways of structuring doctor-patient relationships by studying five innovative practices: 1 ) cancer self-help and advocacy, 2) palliative care, 3) complementary medicine, 4) group visits for chronic illness care, and 5) new communications curricula in medical education. Three research questions will be addressed through study of each of these cases: 1. How can doctor-patient relationships be restructured within the following dimensions to promote patient-centered care: exercise of authority, distribution of responsibility among patients and providers, patient access to expertise, the range of patient needs addressed, affective involvement of both parties, possibilities for authenticity, and maintenance of trust? 2. What are the critical elements that promote or impede application of these innovations in medical practice? How can relationships be reformulated to optimally address specific health problems or serve distinctive patient populations? 3. How do the new possibilities for structuring relationships posed by these cases accord with dominant theoretical perspectives on doctor-patient relationships? How might existing models be revised to more effectively guide future research? A qualitative research approach serves the overall goal of developing new models in unexplored territory. In-depth interviews will be conducted with participants in each case and inductively analyzed to: a) study the dynamics of caring focusing on those features central to effectiveness; b) compare these features across cases and in relation to prevailing models of doctor-patient relationships; c) assess conditions under which each innovation functions, its acceptability to population subgroups, and the potential to expand its application more broadly; and d) generate hypotheses about promising changes in mainstream relationships and approaches for achieving them. The study is designed, first, to illuminate new possibilities for structuring doctor-patient relationships consonant with IOM's agenda for redesign of health care processes. Second, findings will inform initiatives in medical education as a vehicle for preparing doctors to assume new roles. Third, development of new conceptual frameworks and models will guide future research on the impact of doctor-patient relationships on quality of care.

描述：（由申请人提供）提供者与患者关系的转变对于实现以患者为中心的护理的成功至关重要，如IOM报告中所设想的那样，跨越了质量的鸿沟。这项研究将通过研究五种创新实践来调查结构医生关系的新方法：1）癌症自助和倡导，2）姑息治疗，3）补充医学，4）4）慢性疾病护理的小组访问； 5）医学教育中的新通信课程。将通过研究每种情况来解决三个研究问题： 1。如何在以下维度内进行重组，以促进以患者为中心的护理：行使权威，患者和提供者之间的责任分配，患者获得专业知识，患者需求的范围，双方的情感参与，真实性的可能性以及信任的维持？ 2。促进或阻碍这些创新在医学实践中的应用或阻碍应用的关键要素是什么？如何将关系重新恢复以最佳解决特定的健康问题或为独特的患者人群服务？ 3.这些案例构成的新可能性如何符合医生关系的主要理论观点？如何修改现有模型以更有效地指导未来的研究？ 定性研究方法是在未开发领域开发新模型的总体目标。 在每种情况下的参与者将进行深入的访谈，并将其归纳分析： b）在案例中比较这些特征，并与现行医生关系的现行模型进行比较； c）评估每种创新功能，对人口亚组的可接受性以及更广泛扩展其应用的潜力的条件； d）关于主流关系和实现它们的方法的有希望变化的假设。该研究首先旨在阐明与IOM重新设计医疗保健过程的IOM议程结构医生关系辅音的新可能性。其次，调查结果将为医学教育的举措提供信息，作为准备医生担任新角色的工具。第三，开发新的概念框架和模型将指导对医生关系对护理质量的影响的未来研究。