Schouten Barbara C, Meeuwesen Ludwien, Tromp Fred, Harmsen Hans A M
Department of Communication, The Amsterdam School of Communications Research, University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands.
Patient Educ Couns. 2007 Jul;67(1-2):214-23. doi: 10.1016/j.pec.2007.03.018. Epub 2007 May 4.
The primary goal of this study was to examine the extent to which patient participation during medical visits is influenced by patients' ethnic background, patients' culture-related characteristics (e.g. acculturation, locus of control, cultural views) and features of doctors' communicative behaviour. Furthermore, the mutual influence between patients' participatory behaviour and doctors' communicative behaviour was investigated. An additional goal was to identify the independent contribution of these variables to the degree of patient satisfaction and mutual understanding between GP and patient.
Communicative behaviour of patients (n=103) and GPs (n=29) was analysed with Roter's Interaction Analysis System, frequency of patient questions and patients' assertive utterances (e.g. making requests, suggesting alternative treatment options). Additional data were gathered using GP and patient questionnaires after the consultations.
Results show that non-Western ethnic minority patients display less participatory behaviour during medical consultations than Dutch patients. GPs' affective verbal behaviour had most effect on degree of patient participation and patient satisfaction. Regression analyses indicate a significant mutual influence between patients' verbal behaviour and GPs' verbal behaviour.
Overall, results of this study show some important differences between Dutch and non-Western ethnic minority patients in degree of patient participation. Furthermore, our results indicate that patient participation encompasses several aspects that are not necessarily interrelated.
The necessity for continued education of GPs' communicative skills, particularly when dealing with non-Western ethnic minority patients, is reflected in the strong influence of GP's affective verbal behaviour on both patient participation and their satisfaction with the medical encounter.
本研究的主要目标是考察患者在就诊期间的参与程度受患者种族背景、与文化相关的特征（如文化适应、控制点、文化观念）以及医生沟通行为特征的影响程度。此外，还研究了患者参与行为与医生沟通行为之间的相互影响。另一个目标是确定这些变量对患者满意度以及全科医生与患者之间相互理解程度的独立贡献。
采用罗特互动分析系统分析了103名患者和29名全科医生的沟通行为，包括患者提问频率和患者的肯定性话语（如提出请求、建议替代治疗方案）。会诊后还通过全科医生和患者问卷收集了其他数据。
结果显示，非西方少数民族患者在医疗会诊期间的参与行为比荷兰患者少。全科医生的情感性言语行为对患者参与程度和患者满意度影响最大。回归分析表明患者言语行为和全科医生言语行为之间存在显著的相互影响。
总体而言，本研究结果显示荷兰患者和非西方少数民族患者在患者参与程度上存在一些重要差异。此外，我们的结果表明患者参与包含几个不一定相互关联的方面。
全科医生沟通技巧继续教育的必要性，特别是在与非西方少数民族患者打交道时，体现在全科医生情感性言语行为对患者参与及其对医疗接触满意度的强烈影响上。
