How Exam Rooms Enhance Physicians' Patient-Centeredness

描述(由申请人提供)：以患者为中心的沟通继续被认为是老年患者和医生之间治疗关系的核心组成部分。这种交流在很大程度上是在考场的实际环境中发起、发展和维持的。然而，这种物理环境在塑造交流方面的作用还没有得到系统的研究。一项关于医生与老年患者互动的小规模初步研究(N=8)表明，医生在检查室中更多地以患者为中心，身体属性具有促进互动的空间。拟议的研究旨在扩大这一前期工作。这项建议的具体目的是： 1.对初步研究中开发的身体环境属性和以病人为中心的测量进行了预试和修订。调查人员将独立审查20%的磁带，然后合作达成测量仪器的共识。 2.在50次二元相遇中，分别编码和汇编物理环境属性和以患者为中心；对研究的概念基础和彼此的任务视而不见的编码者将被用于这一阶段的研究。 3.运用定性的方法对数据进行分析，勾画出检查室的物理属性与医生以病人为中心相联系的条件。 这项拟议的研究是对50盘医生和老年患者在自然环境下的二元相遇的录像带进行的，是对489盘NIA存档录像带的更大数据集的次要数据分析。 这个数据子集将代表原始样本的中西部和西南地区。它们还将具体代表三种类型的环境，独立执业、管理性护理和学术环境。此外，我们建议将性别和种族特征的混合纳入医生和老年患者。选择这样一个有目的的样本的潜在目标是，它包括各种临床情况，以检查我们的主要问题：检查室的物理环境是医生与老年患者沟通的显著因素吗？

DESCRIPTION (PROVIDED BY APPLICANT): Patient-centered communication continues to be acknowledged as a central component for a therapeutic relationship between older patients and physicians. Much of this communication is initiated, developed and sustained within the physical setting of the exam room. Yet the role of that physical setting in shaping communication has not been systematically examined. A small, preliminary study (N=8) of physician-older patient interactions indicate that physicians were more patient-centered in exam rooms with physical attributes that had the latitude to facilitate interaction. The proposed research seeks to expand this preliminary work. The specific aims of this proposal are to: 1. Pretest and revise measures of physical setting attributes and patient-centeredness developed in the preliminary study. The investigators will review 20% of the tapes independently and then collaboratively to arrive at consensus on measurement instruments. 2. Code and compile physical setting attributes and patient-centeredness separately in fifty dyadic encounters; coders blinded to the conceptual basis of the study and to each other's tasks will be used for this phase of study. 3. Analyze the data and delineate the conditions under which physical attributes of the exam room become linked with physician's patient-centeredness using qualitative method techniques. This proposed study of fifty videotapes of dyadic encounters between physicians and older patients, in their naturally occurring settings, is a secondary data analysis of a larger dataset of 489 NIA archived videotapes. This subset of data will represent both the Midwest and Southwest regions of the original sample. They will also represent three types of settings specifically, independent practice, managed care and academic settings. Further, we propose to include a mix of gender and race characteristics for both physicians and older patients. The underlying goal in selecting such a purposive sample is that it comprises a variety of clinical situations to examine our main question: Is the physical setting of the exam room a salient factor in physicians' communication with their older patients?