Morris Megan A, Clayman Marla L, Peters Kaitlin J, Leppin Aaron L, LeBlanc Annie
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Department of General Internal Medicine, Northwestern University, Chicago, IL, USA.
Disabil Health J. 2015 Apr;8(2):208-15. doi: 10.1016/j.dhjo.2014.09.007. Epub 2014 Oct 13.
Communication during clinical encounters can be challenging with patients with communication disabilities. Physicians have the potential to positively affect the encounter by using communication strategies that engage the patient in patient-centered communication.
We engaged patients and their physicians in defining their preferences for patient-centered communication strategies, then evaluated the use of the identified strategies during observed clinical encounters.
We video-recorded 25 clinical encounters with persons with aphasia. All encounters were previously scheduled with community physicians and a companion was present. Following each encounter, physicians completed a brief questionnaire and the person with aphasia and his or her companion participated in a video elicitation interview.
While many of the communication strategies identified and described by physicians, patients and companions were similar, patients and companions identified three additional key communication strategies. These strategies included (1) using visual aids, (2) writing down key words while speaking, and (3) using gestures. In the video recorded clinical encounters, no physicians wrote down key words while speaking and only one used a visual aid during the clinical encounter. The frequency with which physicians used gestures varied greatly, even within the same patient, suggesting the use of gestures was independent of patient or companion characteristics.
To maximize patient-centered communication with patients with communication disabilities, physicians should use "disability-specific" communication strategies. Our study suggests that physicians should routinely ask patients and companions about communication preferences and then incorporate identified communication strategies into their communication style.
对于有沟通障碍的患者，临床诊疗过程中的沟通可能具有挑战性。医生有可能通过采用让患者参与以患者为中心的沟通策略，对诊疗过程产生积极影响。
我们让患者及其医生确定他们对以患者为中心的沟通策略的偏好，然后评估在观察到的临床诊疗过程中所确定策略的使用情况。
我们对25次与失语症患者的临床诊疗进行了录像。所有诊疗均提前与社区医生预约，并且有一名陪同人员在场。每次诊疗结束后，医生填写一份简短问卷，失语症患者及其陪同人员参与视频诱导访谈。
虽然医生、患者和陪同人员确定并描述的许多沟通策略是相似的，但患者和陪同人员还确定了另外三种关键沟通策略。这些策略包括：（1）使用视觉辅助工具；（2）边说边写下关键词；（3）使用手势。在录像的临床诊疗中，没有医生边说边写下关键词，只有一名医生在临床诊疗过程中使用了视觉辅助工具。医生使用手势的频率差异很大，即使是针对同一名患者，这表明手势的使用与患者或陪同人员的特征无关。
为了最大限度地实现与有沟通障碍患者的以患者为中心的沟通，医生应使用“针对残疾的”沟通策略。我们的研究表明，医生应常规询问患者及其陪同人员的沟通偏好，然后将确定的沟通策略纳入他们的沟通方式中。
