Exploring Origins of Patient Post-Encounter Perceptions

描述(由申请者提供)：本项目的目标是分析医生和患者在就医过程中发生的语言和非语言交流，以及患者对这种交流的看法。在我们的分析中，我们打算揭示每时每刻的言语和非言语行为的重复模式，这些行为触发了患者对他们的医生和医疗接触的整体认知。到目前为止，“传统的”医患沟通研究仅限于比较患者的总体感知和整个医疗接触(长达25-30分钟)的总体沟通行为。我们将通过使用遭遇后刺激回忆来将分析的重点转移到微观细节水平，这是一种在其他研究领域使用了多年的测量技术的改编。医患沟通的一般概念模型，即有效的沟通有助于改善患者的感知，改善患者的自我监控行为，最终改善患者的健康结果，已成为医学和传播学中的工作理论。因此，医生和患者通过了解是什么推动了患者感知的每时每刻的演变，并认识到与这些感知的出现最经常相关的特定语言和非语言行为，从而增加了理想的患者生理结果。我们假设，将遭遇后刺激回忆应用于医患沟通研究将为研究人员提供新的信息，这些信息可能有助于他们在医患接触中识别对患者结果产生影响的时刻。我们建议分三个阶段实施这个项目，与以下具体目标相对应：具体目标1)测试一种基于计算机的技术，用于管理遭遇后刺激回忆，确保患者能够按预期使用系统；具体目标2)开发和测试非语言行为沟通编码系统的可靠性，该系统侧重于与现有言语行为系统相同的医患沟通结构；具体目标3)证明被患者明确识别为驱动他们对医生和医疗遭遇的感知的语言和非语言行为对患者整体遭遇后感知的预测优于对行为的传统总体。

DESCRIPTION (PROVIDED BY APPLICANT): The objective of this project is to analyze moment-by-moment the verbal and non-verbal communication that occurs between physician and patient during a medical encounter, as well as patients' perceptions of this communication. In our analysis, we intend to uncover recurring patterns of moment-by-moment verbal and non-verbal acts that trigger patients' overall perceptions of their physician and the medical encounter. To date, "conventional" physician-patient communication research has been limited to comparison of patients' overall perceptions with overall totals of communication acts tallied from an entire medical encounter (up to 25-30 minutes in length). We will shift the focus of analysis to a micro level of detail by employing postencounter stimulated recall, an adaptation of a measurement technique used for many years in other fields of research. The general conceptual model of physician-patient communication, that is, effective communication leading to improved patient perceptions, to better patient self-monitoring behaviors and ultimately to improved patient health outcomes, has come to be accepted as working theory in the medical and communication sciences. Therefore, physicians and patients stand to increase desirable patient physiological outcomes by understanding what drives the moment-by-moment evolution of patients' perceptions and by recognizing the specific verbal and non-verbal acts that are most often associated with the emergence of those perceptions. We posit that the application of post-encounter stimulated recall to physician-patient communication research will provide researchers new information that may help them identify in physician-patient encounters "moments that make a difference" in patient outcomes. We propose to execute this project in three phases, corresponding to the following specific aims: Specific Aim 1) To test a computer-based technique for administering post-encounter stimulated recall, ensuring that patients are able to use the system as intended; Specific Aim 2) To develop and test the reliability of a communication coding system for non-verbal acts that focuses on the same constructs of physician-patient communication as an existing system for verbal acts; Specific Aim 3) To demonstrate that verbal and non-verbal acts specifically identified by patients as driving their perceptions of physician and medical encounter predict patients' overall post-encounter perceptions better than "conventional" overall totals of acts do.