医患对话对出现新症状或持续症状的初级保健患者行为的影响:一项视频观察研究

Quality & Safety in Health Care Pub Date : 2020-03-01 Epub Date: 2019-07-20 DOI:10.1136/bmjqs-2019-009485
Dorothee Amelung, Katriina L Whitaker, Debby Lennard, Margaret Ogden, Jessica Sheringham, Yin Zhou, Fiona M Walter, Hardeep Singh, Charles Vincent, Georgia Black
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引用次数: 0

摘要

背景大多数癌症是在接触初级保健后诊断出来的。被诊断为癌症的患者在被转诊去看专家之前,经常会多次因潜在的相关症状去看医生,这表明他们错过了医生与患者交谈的机会。目的了解医患沟通中持续或新出现问题的意义及其对癌症及时诊断的潜在影响。研究设计基于初级保健中医患咨询的视频记录以及对患者和医生的随访访谈的定性主题分析。在英格兰的7个全科诊所中,进行了80次视频观察、20次患者访谈和7次医生访谈。结果我们发现,如果医生和患者不能就当前问题的重要性达成一致,诊断的及时性可能会受到不利影响。”分歧可能涉及不一致的认知因素,如医生和患者之间的医学知识差异,或不一致的情绪因素,如患者对诊断程序的恐惧。访谈表明,意见分歧要么没有得到承认,要么一直没有得到解决的对话可能会导致患者在咨询后的无益行为(例如,不参加专家预约),从而造成诊断延误和患者伤害的可能性。结论我们的研究结果强调了当患者出现持续或新的问题时,医患咨询如何影响及时诊断。错位很常见,可能会被忽视,从而留下可能对患者造成伤害的漏洞。这些发现对癌症和其他严重疾病的及时诊断具有重要意义,因为它们突出了咨询的复杂性和流动性以及随后对诊断过程的影响。
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Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study.

Background: Most cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations.

Objective: To understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis.

Research design: Qualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England.

Results: We found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem's significance. 'Disagreements' may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients' unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm.

Conclusions: Our findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.

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来源期刊
Quality & Safety in Health Care
Quality & Safety in Health Care 医学-卫生保健
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