Department of Medicine, University of California, San Francisco, CA 94121, USA.
Patient Educ Couns. 2012 Dec;89(3):368-73. doi: 10.1016/j.pec.2012.02.020. Epub 2012 Apr 6.
To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits.
Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning.
Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment.
Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions.
Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.
通过实证研究，探讨医患双方在初级保健就诊中讨论补充和替代医学（CAM）治疗的方式。
对 256 名 50 岁及以上成年患者和 28 名初级保健医生之间的就诊录音进行了转录，并使用话语分析进行了分析，话语分析是一种关注语言如何用于协商意义的经验社会语言学方法。
82 次就诊（32.0%）中讨论了 128 次 CAM。讨论最多的 CAM 方式是非维生素、非矿物质补充剂和按摩。对三个医患互动进行了逐轮分析，以展示有关 CAM 使用的协商。患者提出 CAM 讨论是为了寻求医生对治疗方法的专业知识，医生则采取了一系列回应，包括鼓励、中立和劝阻。尽管对 CAM 治疗的了解程度不同，但医生会帮助患者评估 CAM 治疗的风险和益处，并根据患者对治疗的偏好提出建议。
无论医生对 CAM 的立场或知识如何，他/她都可以帮助患者协商 CAM 治疗决策。
提供者不必拥有特定 CAM 治疗的广泛知识，就可以与患者进行有意义的讨论，并为患者评估 CAM 治疗的使用提供框架。
