Mead Nicola, Bower Peter, Hann Mark
National Primary Care Research and Development Centre, University of Manchester, UK.
Soc Sci Med. 2002 Jul;55(2):283-99. doi: 10.1016/s0277-9536(01)00171-x.
The concept of patient-centredness is complex, but is generally seen as an approach that emphasises, on the part of the health professional, attention to patients' psychosocial (as well as physical) needs, the use of psychotherapeutic behaviours to convey a sense of partnership and positive regard, and active facilitation of patients' involvement in decision-making about their care. To date, there is little consistent evidence that doctors' use of a 'patient-centred' consulting style leads to better patient outcomes. However, previous studies have been limited by a lack of conceptual clarity and methodological consensus, and by the absence of a clear theoretical framework linking patient-centredness to outcomes. In this study, three specific, conceptually distinct dimensions of a patient-centred consulting style were operationalised: the 'biopsychosocial perspective', 'sharing power and responsibility' and the 'therapeutic alliance'. These dimensions were measured in terms of three 'socio-emotional' and two 'task-relevant' general practitioner (GP) behaviours using in-depth observational techniques applied to 173 videotaped GP consultations. Theoretically-derived hypotheses were tested concerning relationships between these patient-centred behaviours and two different consultation outcomes: patient satisfaction and enablement. Multivariate regression showed that GPs' patient-centred behaviours did not predict either outcome. The robustness of these findings is considered within the context of study strengths and weaknesses, and implications for future research are discussed.
以患者为中心的理念很复杂，但一般被视为一种方法，这种方法强调医护人员要关注患者的心理社会（以及身体）需求，运用心理治疗行为来传达伙伴关系感和积极关注，并积极促进患者参与有关其治疗的决策。迄今为止，几乎没有一致的证据表明医生采用“以患者为中心”的咨询方式能带来更好的患者治疗效果。然而，以往的研究受到概念不清晰、方法缺乏共识以及缺乏将以患者为中心与治疗效果联系起来的明确理论框架的限制。在本研究中，以患者为中心的咨询方式的三个具体的、概念上不同的维度得以实施：“生物心理社会视角”、“分享权力和责任”以及“治疗联盟”。这些维度通过应用于173次全科医生（GP）咨询录像的深入观察技术，根据三种“社会情感”和两种“与任务相关”的全科医生行为进行衡量。对这些以患者为中心的行为与两种不同咨询结果（患者满意度和赋能）之间的关系进行了理论推导假设检验。多元回归显示，全科医生以患者为中心的行为并不能预测任何一种结果。在研究优缺点的背景下考虑了这些发现的稳健性，并讨论了对未来研究的启示。
