Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study
Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study
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DOI：
10.1186/s12909-017-0868-5
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发表时间：
2017-02-02
影响因子：
3.6
通讯作者：
Giordano, Thomas P.
中科院分区：
文献类型：
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作者：
Dang, Bich N.;Westbrook, Robert A.;Giordano, Thomas P.
背景资料：新患者是一个特别脆弱的人群，因为他们有很高的风险错过后续访问或完全放弃护理。然而，很少有数据表明新患者在与新提供者建立关系时重视什么。艾滋病毒感染者可能是研究积极的初始患者-提供者关系的驱动因素的理想人群，因为它是一种慢性和严重的疾病，需要与提供者建立可靠的持续关系。根据患者的真实的经历，本研究旨在确定患者认为从一开始就建立信任和融洽关系的最关键因素。2013年8月至2015年3月，德克萨斯州休斯顿的DeBakey退伍军人事务医疗中心。患者在三个时间点进行了采访：一次之前，他们的第一个供应商访问，第二次在两周内第一次访问后，第三次在6至12个月后，第一个供应商vision.Results：我们进行了61小时的患者访谈。平均年龄为53岁; 52%为非西班牙裔白色，23%为非西班牙裔黑人，19%为西班牙裔。患者描述了严重的焦虑和脆弱性，不仅来自艾滋病毒本身，而且还来自作为新患者与新提供者建立关系。我们对这些经验的分析揭示了提供者可以采取的五种行动来减少患者的焦虑并在第一次就诊时早期建立信任：1）向患者提供保证，2）告诉患者可以提出问题，3）向患者展示他们的实验室结果并解释他们的意思，4）避免对患者进行判断的语言和行为，以及5）询问患者他们想要什么[即，治疗目标和偏好]。结论：我们的研究纳入了患者的直接输入，并强调了患者在寻求新的提供者的护理时面临的独特心理挑战。患者引用的可操作机会有可能减轻患者的焦虑和脆弱感，从而改善他们的整体医疗保健体验。
Background: New patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients' real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset.Methods: We conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit.Results: We conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients' anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it's okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences].Conclusions: Our study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by patients have the potential to mitigate patients' feelings of anxiety and vulnerability, and thereby improve their overall health care experience.