Paul Jean, Metcalfe Sylvia, Stirling Lesley, Wilson Brenda, Hodgson Jan
Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; School of Languages and Linguistics, The University of Melbourne, Melbourne, Australia.
Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
Patient Educ Couns. 2015 Jan;98(1):15-33. doi: 10.1016/j.pec.2014.09.017. Epub 2014 Sep 30.
To systematically review studies that have analyzed communication within medical consultations involving genetic specialists and report on their findings and design.
Drawing from PRISMA and appropriate guidelines for reviewing qualitative research, a systematic search of seven databases was conducted, followed by selection of studies for inclusion based on a set of criteria. Three authors conducted data extraction and narrative synthesis.
Twenty-two studies were identified and were heterogeneous in setting, design, and methods, with many including limited descriptions of health professionals involved. Despite this variability, studies generally pursued the following three main objectives: searching for structural patterns within consultations, investigating communication and genetic counseling concepts, and linking process with input- and outcome-measures. Structural patterns identified included clinician dialog dominating consultations, and talk being mostly biomedical. Counseling and communication concepts investigated were: risk communication, the negotiation of power and knowledge, and adherence to genetic counseling ideals. Attempts to link consultation data to input- or outcome-measures were often unsuccessful.
More interdisciplinary research, grounded in appropriate theoretical frameworks, is needed to explore inherent complexities in this setting.
Findings from this review can be used to guide the design of future research into the process of genetic consultations.
系统回顾分析涉及基因专家的医疗会诊中沟通情况的研究，并报告其研究结果和设计。
依据PRISMA以及定性研究综述的适当指南，对七个数据库进行系统检索，随后根据一系列标准选择纳入研究。三位作者进行数据提取和叙述性综合分析。
共识别出22项研究，这些研究在背景、设计和方法上存在异质性，许多研究对所涉及的卫生专业人员的描述有限。尽管存在这种变异性，但研究通常追求以下三个主要目标：在会诊中寻找结构模式、调查沟通和遗传咨询概念，以及将过程与输入和结果测量联系起来。识别出的结构模式包括临床医生对话主导会诊，且谈话大多是生物医学方面的。所调查的咨询和沟通概念包括：风险沟通、权力和知识的协商，以及对遗传咨询理想的坚持。将会诊数据与输入或结果测量联系起来的尝试往往不成功。
需要更多基于适当理论框架的跨学科研究来探索这种情况下的内在复杂性。
本综述的结果可用于指导未来关于基因会诊过程的研究设计。
