Zoffmann Vibeke, Hörnsten Åsa, Storbækken Solveig, Graue Marit, Rasmussen Bodil, Wahl Astrid, Kirkevold Marit
The Research Unit Women's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
Department of Nursing, Umeå University, Umeå, Sweden.
Patient Educ Couns. 2016 Mar;99(3):400-407. doi: 10.1016/j.pec.2015.10.015. Epub 2015 Oct 30.
Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD].
Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects.
Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools.
Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked.
Professionals must critically consider the context in their choice of approach.
以患者为中心的照护（PCC）有助于慢性病患者过上良好的生活。然而，将PCC转化为实际行动具有挑战性。我们旨在比较三种方法的转化潜力：动机性访谈（MI）、疾病整合支持（IIS）和引导式自我决定（GSD）。
比较分析包括八个组成部分：（1）哲学起源；（2）在原始临床环境中的发展；（3）理论基础；（4）总体目标和支持过程；（5）吸引人们参与的一般原则、策略或工具；（6）医疗保健专业人员的背景和培训；（7）保真度评估；（8）报告的效果。
尽管所有方法都促进了自主动机，但它们在其他方面存在差异。它们的原始环境解释了为什么IIS和GSD致力于生活与疾病的整合，而MI则侧重于处理矛盾心理。IIS和GSD基于扎根理论，而MI是直观发展而来的。所有方法都应用过程和策略来提高专业人员的沟通技巧和参与度；GSD包括针对具体情境的反思表。所有方法都提供培训项目；MI和GSD包括保真度工具。
每种方法都有其主要应用场景：当矛盾心理威胁到积极改变时应用MI；当整合新诊断的慢性病时应用IIS；当解决问题困难或陷入僵局时应用GSD。
专业人员在选择方法时必须审慎考虑具体情境。
