McAnuff Jennifer, Boyes Chris, Kolehmainen Niina
Children's Occupational Therapy Service, Leeds Community Healthcare NHS Trust, Leeds, UK.
Faculty of Health and Life Sciences, York St. John University, York, UK.
Health Expect. 2015 Dec;18(6):2236-51. doi: 10.1111/hex.12194. Epub 2014 Apr 28.
Effective family-clinician interactions are important for good health outcomes. Two types of interactions are consistently recommended: relational (e.g. listening, empathy, and respect) and participatory (e.g. shared decision-making, planning and problem-solving), but there is little specific guidance on how to implement these interactions in practice.
To identify specific, practice-based examples of relational and participatory family-clinician interactions in children's occupational therapy.
A qualitative secondary analysis was used. The data consisted of a list of occupational therapists' self-reported practice actions (n = 217) and direct quotes describing their content and context. The practice actions were categorized into a range of relational and participatory family-centred interactions using a modified framework analysis.
Of the 217 practice actions, the majority [121 (55.76%)] did not describe examples of therapists implementing family-clinician interactions. Of the remaining practice actions, 19 (8.76%) described 'relational' interactions (e.g. 'Listen to carer', 'Gather perspectives from others'); 47 (21.66%) described 'participatory' interactions (e.g. 'Identify the family's goals and priorities', 'Allow the family to choose'); 2 (0.92%) described both ('Take guidance from carers'); and 28 (12.9%) were excluded from the analysis.
A range of relational and participatory interactions were identified. Descriptions of participatory interactions were more frequent than descriptions of relational interactions, and overall the therapists described their family-clinician interactions less frequently than their other practice actions. The specific, real-life examples of different types of interactions identified in the study can be used as a basis for reflection on practice and developing more specific guidance.
有效的家庭与临床医生互动对于良好的健康结果至关重要。一直以来推荐两种互动类型：关系型（如倾听、共情和尊重）和参与型（如共同决策、规划和解决问题），但对于如何在实践中实施这些互动几乎没有具体指导。
确定儿童职业治疗中关系型和参与型家庭与临床医生互动的基于实践的具体示例。
采用定性二次分析。数据包括职业治疗师自我报告的实践行为列表（n = 217）以及描述其内容和背景的直接引语。使用改良的框架分析将实践行为分类为一系列关系型和以家庭为中心的参与型互动。
在217项实践行为中，大多数[121项（55.76%）]未描述治疗师实施家庭与临床医生互动的示例。在其余的实践行为中，19项（8.76%）描述了“关系型”互动（如“倾听照顾者的意见”、“收集他人的观点”）；47项（21.66%）描述了“参与型”互动（如“确定家庭的目标和优先事项”、“让家庭进行选择”）；2项（0.92%）同时描述了两者（“听取照顾者的指导”）；28项（12.9%）被排除在分析之外。
确定了一系列关系型和参与型互动。对参与型互动的描述比对关系型互动的描述更频繁，总体而言，治疗师对其家庭与临床医生互动的描述比对其他实践行为的描述更少。该研究中确定的不同类型互动的具体现实生活示例可作为反思实践和制定更具体指导的基础。
