NIVEL, Netherlands Institute for Health Services Research, The Netherlands.
NIVEL, Netherlands Institute for Health Services Research, The Netherlands; Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands.
Patient Educ Couns. 2014 Mar;94(3):314-21. doi: 10.1016/j.pec.2013.11.004. Epub 2013 Nov 28.
To examine whether GPs' communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s.
From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations assessed by GPs as 'completely psychosocial' were coded with RIAS (Roter Interaction Analysis System). The 121 consultations prior to and 391 consultations after implementation of guidelines were analyzed whether communication styles have changed over time.
We found that GPs were more likely to consider consultations to be mainly (17%) or completely (12%) psychosocial after the implementation of guidelines. They gave more biomedical and psychosocial information and advice in the second period compared to the first period. We also found that empathy decreased over time (frequency of empathic statements by GPs changed from 2.9-3.2 to 1.4-1.6 between periods).
Communication in psychosocial consultations has changed; GPs have become more focused on task-oriented communication (asking questions, giving information and advice) and less on showing empathy.
GPs face the challenge of integrating an evidence-based approach of applying guidelines that promote active symptom exploration with understanding patients' personal contexts and giving room to their emotions.
考察自 20 世纪 90 年代荷兰普通实践中引入和实施心理社会问题临床指南以来，全科医生的沟通方式是否发生了变化。
从 1977 年至 2008 年期间录制的 5184 次咨询视频数据库中，选择了 512 次由全科医生评估为“完全心理社会”的咨询进行 RIAS（Roter 互动分析系统）编码。分析了指南实施前后的 121 次咨询和 391 次咨询，以确定沟通方式是否随时间发生了变化。
我们发现，在实施指南后，全科医生更倾向于认为咨询主要（17%）或完全（12%）是心理社会问题。与第一阶段相比，他们在第二阶段提供了更多的生物医学和心理社会信息和建议。我们还发现，同理心随时间推移而下降（全科医生同理心陈述的频率从 2.9-3.2 变为 1.4-1.6）。
心理社会咨询中的沟通方式发生了变化；全科医生更关注任务导向的沟通（提问、提供信息和建议），而较少关注表现同理心。
全科医生面临着将基于证据的应用指南的方法与理解患者个人背景和为他们的情绪留出空间相结合的挑战。
