Milton Alyssa C, Mullan Barbara, Hunt Caroline
School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2016 May;51(5):735-46. doi: 10.1007/s00127-016-1187-6. Epub 2016 Feb 15.
Communication of a mental health diagnosis can be a difficult process and is a poorly understood area of service provision. The aim of this qualitative study was to examine clinicians' perceptions of barriers and helpful strategies to discussing information about a mental health condition.
Qualitative interviews with 19 Australian clinicians (general practitioners, mental health nurses, psychiatrists, and psychologists) working in several settings (community, hospital inpatient, outpatient, accident and emergency) and locations (urban, suburban and rural) were conducted and analysed thematically.
After theme saturation was reached, four primary themes relating to barriers and facilitators to communication at the time of diagnosis were identified in the data. Outside a recognised lack of focus on this area in training, themes included (1) engagement and timing of conversations; (2) stigma and its reduction; (3) perceived and desired knowledge for diagnostic information; and (4) working with distress. The synthesis of themes is demonstrated in a flowchart of suggestions for communicating news of mental health diagnosis that tracks the patient journey in receiving information from initial engagement to follow-up.
Talking with an individual about a mental health diagnosis is a non-linear, complex and changeable situation. However, health professionals report using specific strategies to aid this communication process, to meet the specific individual's needs. Strategies such as tailoring to the person's situation, utilising collaborative practice, effective coordination, and addressing stigma may be useful to inform clinician training and support whilst diagnosis remains a key feature of the mental health system in Australia.
传达心理健康诊断可能是一个艰难的过程,且是服务提供中一个鲜为人知的领域。这项定性研究的目的是考察临床医生对于讨论心理健康状况信息时所面临的障碍以及有用策略的看法。
对19名在多个场所(社区、医院住院部、门诊部、急诊室)以及不同地点(城市、郊区和农村)工作的澳大利亚临床医生(全科医生、心理健康护士、精神科医生和心理学家)进行了定性访谈,并进行了主题分析。
在达到主题饱和后,数据中确定了与诊断时沟通的障碍和促进因素相关的四个主要主题。除了公认的培训中对该领域缺乏关注外,主题还包括:(1)谈话的参与度和时机;(2)污名化及其减少;(3)对诊断信息的认知和期望的知识;(4)应对困扰。这些主题的综合体现在一个心理健康诊断消息沟通建议流程图中,该流程图跟踪了患者从最初接触到后续跟进接收信息的过程。
与个人谈论心理健康诊断是一个非线性、复杂且多变的情况。然而,卫生专业人员报告称使用特定策略来辅助这一沟通过程,以满足特定个体的需求。诸如根据个人情况量身定制、采用协作实践、有效协调以及消除污名等策略,可能有助于为临床医生培训和支持提供信息,而诊断仍是澳大利亚心理健康系统的一个关键特征。