Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Patient Educ Couns. 2013 Oct;93(1):73-9. doi: 10.1016/j.pec.2013.05.015. Epub 2013 Jul 12.
Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist-patient communication is associated with better treatment adherence in schizophrenia.
Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients' symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke.
138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31-25.82, p=0.02).
The quality of doctor-patient communication also appears to influence adherence in schizophrenia.
Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists' communication.
有效的医患沟通，包括共同理解，与医学领域的治疗依从性相关。然而，沟通会受到精神分裂症诊断的影响，并且达成共同理解可能具有挑战性。在对话中，人们会通过一种称为“修复”的会话过程来检测和处理可能的误解。本研究检验了以下假设，即精神科医生与患者沟通中更频繁的修复与精神分裂症患者更好的治疗依从性相关。
对涉及（DSM-IV）精神分裂症或分裂情感障碍患者的常规精神科会诊进行音频可视化记录。对会诊进行修复编码，并评估患者的症状和洞察力。六个月后评估依从性。主成分分析对修复数据进行了简化，以便进一步分析。随机效应模型调整了症状、咨询时长和患者发言量，以检验修复与依从性之间的关联。
共记录了 138 次会诊，随访了 118 次。患者要求澄清精神科医生的谈话内容，以及精神科医生提供的澄清，与六个月后的依从性相关（OR 5.82，95%CI 1.31-25.82，p=0.02）。
医患沟通的质量似乎也会影响精神分裂症患者的依从性。
未来的研究应调查如何鼓励患者澄清，并由精神科医生的沟通促进澄清。
