Morton LaKrista, Elliott Alison, Cleland Jennifer, Deary Vincent, Burton Christopher
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Division of Medical and Dental Education, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Patient Educ Couns. 2017 Feb;100(2):224-230. doi: 10.1016/j.pec.2016.08.015. Epub 2016 Aug 17.
To develop a taxonomy of explanations for patients with persistent physical symptoms.
We analysed doctors' explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often "medically-unexplained," physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations.
We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts - generic statements about normal or dysfunctional processes; Causes - person-specific statements about proximal or distal causes for symptoms; Mechanisms - processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components.
This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency.
The taxonomy is suitable for examining explanations and developing prototype explanatory scripts in both training and research settings.
为患有持续性身体症状的患者制定一种解释分类法。
我们分析了两项针对有多种（通常是“医学上无法解释的”）身体症状患者的中度密集咨询干预研究中医生给出的解释。我们采用持续比较法制定了一种分类法，然后将其应用于所有逐字记录的解释。
我们分析了五位全科医生向38名患者提供的138条解释。该分类法包括解释类型和解释成分。三种解释类型描述了解释的总体结构：理性适应型、自动适应型和复杂型。这些在解释中赋予行为主体的是谁或什么方面存在差异。三种解释成分描述了解释的内容：事实——关于正常或功能失调过程的一般性陈述；原因——关于症状近端或远端原因的针对个人的陈述；机制——症状在个体中出现或持续的过程。大多数解释符合一种类型，并包含几个成分。
这种用于对临床解释进行分类的新颖分类法允许对解释类型和内容进行详细分类。解释类型似乎带有不同的行为主体含义。
该分类法适用于在培训和研究环境中检查解释并开发原型解释脚本。
