心血管疾病风险患者从预防性咨询中获得的益处及未满足的期望:一项定性研究
Cardiovascular-risk patients' experienced benefits and unfulfilled expectations from preventive consultations: a qualitative study.
作者信息
Kehler Dea, Christensen Bo, Lauritzen Torsten, Christensen Morten Bondo, Edwards Adrian, Bech Risør Mette
机构信息
Institute of Public Health, the Research Unit and Department of General Practice, University of Aarhus, Denmark.
出版信息
Qual Prim Care. 2008;16(5):315-25.
BACKGROUND
The development of consultations towards more patient centredness and shared decision making has greatly influenced general practice. Several patient-based studies have been published on shared decision making in screening and health checks. However, few studies have explored the process in-depth to understand perspectives of patients at high cardiovascular risk and their experiences of preventive consultations.
AIM
To explore and analyse experiences of preventive consultations in patients at high cardiovascular risk.
METHOD
Individual, semi-structured interviews with 12 patients at increased risk of cardiovascular disease (CVD) conducted within two weeks of a dedicated preventive consultation. Grounded theory was used in the analysis.
RESULTS
The patients' experienced benefits from the consultation included changed emotions, thoughts, readiness to change lifestyle and perceived knowledge related to health and risk. Patients reported that their experienced benefits were related to the general practitioner's (GP's) professional competence, communication in the consultation and especially the doctor-patient relationship. Patients also expressed a number of unfulfilled expectations concerning their opportunities to contribute their personal perspectives to the consultation, short consultation duration, problems with appropriate timing and personal relevance of content and insufficient tailoring to their personal situation. GPs' communication skills and scheduling of follow-up consultations were reported by the patients as essential for these specific aspects to be addressed successfully.
CONCLUSION
Patients reported a number of benefits from preventive consultations. However, their unfulfilled expectations suggest the benefits could be even greater, both with enhanced communication skills from doctors, and attention to appropriate timing of the consultations at stages of life when patients are more able to make changes.
背景
向更以患者为中心和共同决策的咨询方式的发展极大地影响了全科医疗。已有多项基于患者的关于筛查和健康检查中共同决策的研究发表。然而,很少有研究深入探讨这一过程,以了解心血管疾病高风险患者的观点及其预防性咨询的经历。
目的
探讨和分析心血管疾病高风险患者的预防性咨询经历。
方法
在专门的预防性咨询后两周内,对12名心血管疾病风险增加的患者进行了个体半结构式访谈。分析采用扎根理论。
结果
患者从咨询中获得的益处包括情绪、思想的改变,改变生活方式的意愿以及对健康和风险的认知。患者报告称,他们获得的益处与全科医生的专业能力、咨询中的沟通,尤其是医患关系有关。患者还表达了一些未实现的期望,涉及他们在咨询中表达个人观点的机会、咨询时间短、时机合适性和内容的个人相关性问题以及未充分根据个人情况进行调整。患者报告称,全科医生的沟通技巧和后续咨询的安排对于成功解决这些具体问题至关重要。
结论
患者报告称预防性咨询有诸多益处。然而,他们未实现的期望表明,通过提高医生的沟通技巧以及关注患者更有能力做出改变的人生阶段的咨询合适时机,益处可能会更大。