Flickinger Tabor E, Saha Somnath, Roter Debra, Korthuis P Todd, Sharp Victoria, Cohn Jonathan, Moore Richard D, Ingersoll Karen S, Beach Mary Catherine
Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
Department of Medicine, Portland VA Medical Center, Portland, OR, USA; Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
Patient Educ Couns. 2016 Feb;99(2):250-5. doi: 10.1016/j.pec.2015.08.020. Epub 2015 Aug 20.
Attitudes towards patients may influence how clinicians interact. We investigated whether respect for patients was associated with communication behaviors during HIV care encounters.
We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes.
When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92-4.59)], more positive patient emotional tone [2.71 (1.75-4.21)], less clinician verbal dominance [0.81 (0.68-0.96)] and more patient-centeredness [1.28 (1.09-1.51)].
Respect is associated with positive and patient-centered communication behaviors during encounters.
Clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients. Educators should consider methods to enhance trainees' respect in communication skills training.
对患者的态度可能会影响临床医生的互动方式。我们调查了在艾滋病护理过程中,对患者的尊重是否与沟通行为相关。
我们分析了413名成年艾滋病病毒感染患者与45名初级艾滋病护理提供者之间就诊的音频记录。自变量是临床医生报告的对患者的尊重程度,结果是通过罗特互动分析系统(RIAS)评估的临床医生和患者的沟通行为。我们对计数结果进行了负二项回归,对整体结果进行了线性回归。
当临床医生对患者的尊重程度较高时,他们会进行更多建立融洽关系、社交闲聊和积极交流。受到临床医生更高尊重的患者会进行更多建立融洽关系、社交闲聊、积极交流,并提供更多心理社会信息。患者与受到他们更高尊重的临床医生之间的交流,临床医生的情绪基调更积极[回归系数2.97(1.92 - 4.59)],患者的情绪基调更积极[2.71(1.75 - 4.21)],临床医生的言语主导性更低[0.81(0.68 - 0.96)],以患者为中心的程度更高[1.28(1.09 - 1.51)]。
在交流过程中尊重与积极的、以患者为中心的沟通行为相关。
临床医生应注意自己的尊重态度,并努力培养对患者的积极关注。教育工作者应考虑在沟通技能培训中增强学员尊重意识的方法。