Moran Galia S, Oz Galit, Karnieli-Miller Orit
Health, University of Haifa, Haifa, Israel.
Tel-Aviv University, Tel Aviv, Israel
Qual Health Res. 2014 Oct;24(10):1368-80. doi: 10.1177/1049732314547085. Epub 2014 Aug 21.
Doctors' clear disclosure of diagnoses to patients is fundamental to patient autonomy and patient-centered approaches in health care. Although diagnosis disclosure is common in general health, it is less so in psychiatry. The aim of this study was to explore psychiatrists' experiences of schizophrenia diagnosis disclosure to patients and/or family members. We conducted in-depth interviews with 14 psychiatrists from hospital and community settings in Israel and used a phenomenological framework to analyze the interviews. Overall, psychiatrists experienced disclosure as problematic, unproductive, and harmful. We identified 10 themes of psychiatrist experiences and concerns conceptualized under three domains: (a) characteristics of schizophrenia, (b) the doctor-patient/family relationship, and (c) psychiatrists' difficulties with the disclosure task. We discuss the results suggesting a multilayered model of medical, relational, social, and personal disclosure challenges. We suggest that a constructive schizophrenia diagnosis disclosure needs to take into account psychiatrist- and patient-related factors and specify possible directions.
医生向患者清晰披露诊断结果是医疗保健中患者自主权和以患者为中心的方法的基础。尽管诊断披露在一般医疗中很常见，但在精神病学领域却不那么常见。本研究的目的是探讨精神科医生向患者和/或家庭成员披露精神分裂症诊断的经历。我们对以色列医院和社区环境中的14名精神科医生进行了深入访谈，并使用现象学框架对访谈进行分析。总体而言，精神科医生认为披露诊断结果存在问题、没有成效且有害。我们确定了精神科医生经历和担忧的10个主题，这些主题在三个领域中概念化：（a）精神分裂症的特征，（b）医患/家庭关系，以及（c）精神科医生在披露任务方面的困难。我们讨论了结果，提出了一个关于医疗、关系、社会和个人披露挑战的多层次模型。我们建议，建设性的精神分裂症诊断披露需要考虑精神科医生和患者相关因素，并指明可能的方向。
