Hamilton Heidi E, Nelson Meaghan, Martin Paul, Cotler Scott J
Georgetown University, Washington, DC, USA.
Clin Gastroenterol Hepatol. 2006 Apr;4(4):507-13. doi: 10.1016/j.cgh.2005.10.008.
BACKGROUND & AIMS: Providers need to communicate projected response rates effectively to enable patients with hepatitis C virus to make informed decisions about therapy. This study used interactional sociolinguistics (1) to evaluate how gastroenterologists and allied health professionals communicate information regarding response rates to antiviral therapy, (2) to determine how these discussions relate to where the patient is in the continuum of evaluation and treatment, (3) to assess whether patients were aligned with providers in their perceptions of response rates after office visits, and (4) to identify factors that improve provider-patient alignment.
Gastroenterologists, allied health professionals, and patients with hepatitis C virus were videotaped and audiotaped during regularly scheduled visits. Postvisit interviews were conducted separately with patients and providers. Visits and postvisits were transcribed and analyzed using validated sociolinguistic techniques.
The phase of hepatitis C virus treatment shaped the benchmarks of response talk, although across the treatment continuum providers overwhelmingly made strategic use of positive statistics, providing motivation. In postvisit interviews, 55% of providers and patients were aligned on response rates. Patients with a favorable outcome and patients who asked response-related questions in the visit were more likely to be aligned with providers. Areas identified for improvement included the tendency to discuss response rates before an individualized assessment could be made, balancing motivation and accuracy, and assessing the patient's perspective before delivering any bad news, if necessary.
Sociolinguistic analysis provides a powerful tool to evaluate provider-patient interactions and to identify ways to improve in-office communication regarding antiviral therapy.
医疗服务提供者需要有效地传达预期的应答率，以便丙型肝炎病毒患者能够就治疗做出明智的决定。本研究运用互动社会语言学方法：（1）评估胃肠病学家和相关医疗专业人员如何传达有关抗病毒治疗应答率的信息；（2）确定这些讨论与患者在评估和治疗连续过程中的位置有何关联；（3）评估就诊后患者与医疗服务提供者在应答率认知上是否一致；（4）识别能改善医疗服务提供者与患者认知一致性的因素。
在定期就诊期间，对胃肠病学家、相关医疗专业人员和丙型肝炎病毒患者进行录像和录音。分别对患者和医疗服务提供者进行就诊后访谈。使用经过验证的社会语言学技术对就诊和就诊后访谈内容进行转录和分析。
丙型肝炎病毒治疗阶段决定了应答率讨论的基准，尽管在整个治疗过程中，医疗服务提供者绝大多数都策略性地使用了积极的数据来提供激励。在就诊后访谈中，55%的医疗服务提供者和患者在应答率方面认知一致。治疗结果良好的患者以及在就诊时询问应答相关问题的患者更有可能与医疗服务提供者认知一致。确定需要改进的方面包括：在进行个体化评估之前就讨论应答率的倾向、平衡激励与准确性，以及在必要时传递任何坏消息之前评估患者的观点。
社会语言学分析提供了一个强大的工具，可用于评估医疗服务提供者与患者之间的互动，并确定改善关于抗病毒治疗的门诊沟通的方法。
