Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Geriatric Medicine and Gerontology and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Am Geriatr Soc. 2014 Feb;62(2):312-9. doi: 10.1111/jgs.12639. Epub 2014 Jan 13.
To determine the acceptability of a pre-consultation checklist for older adults who attend medical visits with an unpaid companion and to evaluate its effects on visit communication.
Randomized controlled pilot study.
Academic geriatrics ambulatory clinic.
Thirty-two individuals aged 65 and older and their unpaid companions.
A self-administered checklist was compared with usual care. The checklist was designed to elicit and align patient and companion perspectives regarding health concerns to discuss with the doctor and stimulate discussion about the companion's role in the visit.
ratio of patient-centered communication, coded from visit audiotapes.
checklist acceptability; visit duration; patient-companion verbal activity; patient- and physician-reported perspectives of the visit.
All intervention patients and companions (n = 17) completed the checklist, and all participants (n = 32 dyads) completed the study. Patients and companions stated that the checklist was easy to complete (88%) and useful (91%), and they uniformly (100%) recommended it to other patients. Communication was significantly more patient-centered in intervention group visits (ratio of 1.22 vs 0.71; P = .03). Visit duration (35.0 and 30.6 minutes; P = .34) and percentage of total verbal activity contributed by patients and companions (58.2% and 56.3% of visit statements; P = .50) were comparable in the intervention and control groups, respectively. Physicians were more likely to indicate that intervention companions "helped them provide good care to the patient" (94% vs 60%; P = .02). Intervention patients were more likely to indicate that they "better understood their doctor's advice and explanations" because their companion was present (82% vs 47%; P = .03).
A checklist to elicit and align perspectives of older adults and their companions resulted in enhanced patient-centered medical visit communication.
确定一份预咨询清单在陪同老年人就诊的无报酬陪同者中的可接受性，并评估其对就诊沟通的影响。
随机对照试点研究。
学术老年科门诊。
32 名 65 岁及以上的老年人及其无报酬的陪同者。
自我管理清单与常规护理进行比较。该清单旨在引出并协调患者和陪同者对与医生讨论的健康问题的看法，并激发有关陪同者在就诊中角色的讨论。
从就诊录音带中编码的以患者为中心的沟通比例。
清单的可接受性；就诊时间；患者-陪同者言语活动；患者和医生对就诊的看法。
所有干预组的患者和陪同者（n = 17）都完成了清单，所有参与者（n = 32 对）都完成了研究。患者和陪同者表示清单填写容易（88%）且有用（91%），他们一致（100%）向其他患者推荐。干预组就诊时的沟通明显更加以患者为中心（比例为 1.22 比 0.71；P =.03）。干预组和对照组的就诊时间（分别为 35.0 和 30.6 分钟；P =.34）和患者与陪同者在就诊陈述中贡献的总言语活动比例（分别为就诊陈述的 58.2%和 56.3%；P =.50）相似。医生更有可能表示，干预组的陪同者“帮助他们为患者提供了良好的护理”（94%比 60%；P =.02）。干预组的患者更有可能表示，因为他们的陪同者在场，他们“更好地理解了医生的建议和解释”（82%比 47%；P =.03）。
一份引出并协调老年人及其陪同者观点的清单导致了以患者为中心的就诊沟通增强。
