Hopayian Kevork, Notley Caitlin
Leiston Surgery, Main Street, Leiston, Suffolk IP16 4ES, England; Norwich Medical School, Department of Population Health and Primary Care, University of East Anglia, Earlham Road, NR4 7TJ, Norfolk, England.
Norwich Medical School, Department of Population Health and Primary Care, University of East Anglia, Earlham Road, NR4 7TJ, Norfolk, England.
Spine J. 2014 Aug 1;14(8):1769-80. doi: 10.1016/j.spinee.2014.02.029. Epub 2014 Apr 29.
Previous systematic reviews of patients' experience of health services have used mixed qualitative and quantitative studies. This review focused on qualitative studies, which are more suitable for capturing experience, using modern methods of synthesis of qualitative studies.
To describe the experience of health care of low back pain and sciatica patients and the sources of satisfaction or dissatisfaction with special reference to patients who do not receive a diagnosis.
A systematic review of qualitative studies.
Primary qualitative studies identified from Medline, Embase, CINAHL, and Psychinfo databases.
Conceptual themes of patients' experiences.
Data collection and analysis were through thematic content analysis. Two reviewers independently screened titles and collected and analyzed data. The authors were in receipt of a Primary Care Research Bursary from National Health Service Suffolk and Norfolk Research Departments, a not-for-profit organization.
Twenty-eight articles met the inclusion criteria. Most studies were of high quality. Nine themes emerged: the process and content of care, relationships and interpersonal skills, personalized care, information, the outcome of care, the importance of a diagnosis, delegitimation, recognizing the expert, and service matters. How care was given mattered greatly to patients, with importance given to receiving a perceived full assessment, consideration for the individual's context, good relationships, empathy, and the sharing of information. These aspects of care facilitated the acceptance by some of the limitations of health care and were spread across disciplines. Not having a diagnosis made coping more difficult for some but for others led to delegitimation, a feeling of not being believed. Service matters such as cost and waiting time received little mention.
Although much research into the development of chronic low back pain (LBP) has focused on the patient, this review suggests that research into aspects of care also warrant research. The benefits of generic principles of care, such as personalization and communication, are important to patients with LBP and sciatica; so, practitioners may help their patients by paying as much attention to them as to specific interventions. When neither cure nor a diagnostic label is forthcoming, generic skills remain important for patient satisfaction.
以往对患者医疗服务体验的系统评价采用了定性和定量研究相结合的方法。本评价聚焦于定性研究，这类研究更适合运用现代定性研究综合方法来捕捉体验。
描述腰痛和坐骨神经痛患者的医疗体验以及满意或不满意的来源，特别提及未得到诊断的患者。
对定性研究的系统评价。
从Medline、Embase、CINAHL和Psychinfo数据库中识别出的原发性定性研究。
患者体验的概念主题。
通过主题内容分析进行数据收集和分析。两名评审员独立筛选标题并收集和分析数据。作者获得了来自国民保健服务萨福克和诺福克研究部门（一个非营利组织）的初级保健研究助学金。
28篇文章符合纳入标准。大多数研究质量较高。出现了九个主题：护理过程和内容、关系及人际技能、个性化护理、信息、护理结果、诊断的重要性、去合法化、认可专家以及服务事项。护理的提供方式对患者至关重要，患者重视得到全面评估、考虑个体情况、良好关系、同理心以及信息共享。护理的这些方面有助于一些患者接受医疗保健的局限性，且涉及多个学科。未得到诊断对一些患者来说应对起来更加困难，但对另一些患者来说则导致去合法化，即一种不被信任的感觉。诸如费用和等待时间等服务事项很少被提及。
尽管对慢性腰痛（LBP）发展的许多研究都聚焦于患者，但本评价表明对护理方面的研究也值得关注。护理的通用原则，如个性化和沟通，对LBP和坐骨神经痛患者很重要；因此，从业者在关注特定干预措施的同时，给予患者同样多的关注可能有助于患者。当既无法治愈也没有诊断标签时，通用技能对于患者满意度仍然很重要。
