Rethinking Doctor-Patient Relationships

重新思考医患关系

• 批准号: 6908201
• 负责人: Michael Joel Yedidia
• 金额: $ 0.98万
• 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 2006-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6908201
• 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-患者关系的转变对于实现国际移民组织报告中所设想的以患者为中心的护理的成功至关重要，跨越质量鸿沟。这项研究将通过研究五个创新实践来探索构建医患关系的新方法：1)癌症自助和宣传，2)姑息治疗，3)补充医学，4)慢性病护理小组访问，5)医学教育中的新沟通课程。通过对每个案例的研究，将提出三个研究问题： 1.如何在以下方面重组医患关系，以促进以患者为中心的护理：行使权力，在患者和提供者之间分配责任，患者获得专业知识，满足患者需求的范围，双方的情感参与，真实性的可能性，以及保持信任？ 2.促进或阻碍这些创新在医疗实践中应用的关键因素是什么？如何重新制定关系，以最佳地解决特定的健康问题或服务于不同的患者群体？ 3.这些案例提出的构建医患关系的新可能性如何符合医患关系的主导理论观点？如何修改现有的模型以更有效地指导未来的研究？ 定性研究方法服务于在未知领域开发新模型的总体目标。将对每个病例的参与者进行深入访谈，并进行归纳分析，以：a)研究护理的动态，重点放在那些对有效性至关重要的特征上；b)比较不同病例的这些特征以及与主流医患关系模式有关的这些特征；c)评估每项创新的发挥作用的条件、其对人群亚群的接受度以及扩大其更广泛应用的潜力；以及d)产生关于主流关系和实现这些变化的方法有望改变的假设。这项研究的目的是，首先，阐明与国际移民组织重新设计卫生保健程序的议程相一致的构建医患关系的新可能性。其次，研究结果将为医学教育中的倡议提供信息，作为为医生承担新角色做准备的载体。第三，开发新的概念框架和模型将指导未来关于医患关系对护理质量影响的研究。