Brody D S, Miller S M, Lerman C E, Smith D G, Caputo G C
Section of General Internal Medicine, Temple University School of Medicine, Philadelphia, PA 19140.
J Gen Intern Med. 1989 Nov-Dec;4(6):506-11. doi: 10.1007/BF02599549.
The purpose of this study was to explore the relationships among patients' perceptions about the roles they played during medical visits, their subsequent attitudes about their illnesses and treatments, and their self-rated improvement.
Questionnaires were completed by patients before, one day after, and one week after their medical visits, and by their physicians following the visits.
The study was conducted in a general internal medicine faculty practice that provided adult primary care to a largely HMO population.
Adult patients with new or increased symptoms who were capable of reading and understanding the study questionnaire.
Fifty-five patients (47%) reported playing an active role; 62 patients (53%) reported playing a passive role. After adjusting for age, sex, baseline illness ratings, and physician-rated prognosis, "active" patients reported less discomfort (p = 0.04), greater alleviation of symptoms (p = 0.008), and more improvement in their general medical condition (p = 0.04) one week after the visits than did "passive" patients. These differences were not influenced by the roles patients desired to play. Active patients also reported less concern with their illnesses (p = 0.04), a greater sense of control of their illnesses (p = 0.04), and more satisfaction with their physicians (p = 0.02) one day after the visit. Post-visit dysfunction ratings were not related to patients' role perceptions.
Patients' perceptions about their involvement in care appeared to be related to their attitudes about their illnesses as well as to recovery. Further research is needed, however, to determine the factors that influence these role perceptions and to define the types of patients, illnesses, and settings in which the benefits of active-role perceptions are most likely to be realized.
本研究旨在探讨患者对其在就诊过程中所扮演角色的认知、他们随后对疾病及治疗的态度以及自我评定的改善情况之间的关系。
患者在就诊前、就诊后一天和一周时填写问卷，医生在就诊后填写问卷。
该研究在一个普通内科教职员工诊所进行，该诊所主要为健康维护组织（HMO）的成年人群提供初级医疗服务。
有新症状或症状加重、能够阅读并理解研究问卷的成年患者。
55名患者（47%）报告扮演积极角色；62名患者（53%）报告扮演消极角色。在对年龄、性别、基线疾病评分和医生评定的预后进行调整后，“积极”患者在就诊一周后报告的不适更少（p = 0.04）、症状缓解更明显（p = 0.008）、总体健康状况改善更大（p = 0.04），而“消极”患者则不然。这些差异不受患者期望扮演的角色影响。积极患者在就诊一天后还报告对疾病的担忧更少（p = 0.04）、对疾病的控制感更强（p = 0.04）、对医生的满意度更高（p = 0.02）。就诊后的功能障碍评分与患者的角色认知无关。
患者对其参与医疗护理的认知似乎与其对疾病的态度以及康复情况有关。然而，需要进一步研究以确定影响这些角色认知的因素，并确定在哪些类型的患者、疾病和环境中，积极角色认知的益处最有可能实现。
