精神卫生诊断时的沟通障碍和促进因素评估：对卫生专业人员实践的调查。
An evaluation of communication barriers and facilitators at the time of a mental health diagnosis: a survey of health professional practices.
机构信息
School of Psychology,The University of Sydney,Sydney,Australia.
Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology,Curtin University,Perth,Australia.
出版信息
Epidemiol Psychiatr Sci. 2018 Aug;27(4):357-368. doi: 10.1017/S2045796016001153. Epub 2017 Jan 24.
AIMS
To examine health professionals' views and practices relating to the specific barriers to communication that arise at the time of mental health diagnosis, and the strategies used to support individuals throughout this process.
METHODS
An online survey of the beliefs and practices of 131 mental health clinicians working in different clinical settings across Australia was conducted.
RESULTS
Exploratory factor analysis of the items relating to barriers to communication resulted in three latent factors ('stigma, diagnosis and risk'; 'service structure'; and 'individual circumstances' such as the person receiving the diagnosis being young, having a culturally and linguistically diverse background or being unwell at the time of conversation). Using linear regression it was found that variance in 'stigma, diagnosis and risk' was significantly explained by whether participating clinicians had medical training, their experience working with serious mental health problems, their confidence handling distress and attitude towards diagnosis. Variance in 'individual circumstances' was significantly explained by participating clinicians' confidence handling distress. The most frequently used strategies to support diagnostic discussions centred on the health professionals' communication skills, gauging the individual's perception of their circumstances, responding with empathy, following-up after discussion, addressing stigma concerns, using collaborative practice and setting up for the conversation.
CONCLUSIONS
Three main areas for health professionals to reflect on, plan for and ultimately address when discussing news with the individual concerned emerged ('stigma, diagnosis and risk'; 'service structure'; and 'individual circumstances'). Variations in practice indicate that practitioners should be cognisant of their own beliefs and background and how this impacts their communication practice.
目的
探讨卫生专业人员在进行心理健康诊断时遇到的具体沟通障碍的观点和做法，以及在整个过程中支持个体的策略。
方法
对澳大利亚不同临床环境中工作的 131 名心理健康临床医生的信念和实践进行了在线调查。
结果
对与沟通障碍相关的项目进行探索性因素分析，得出三个潜在因素（“污名化、诊断和风险”；“服务结构”；以及“个体情况”，如接受诊断的人年龄较小、具有文化和语言多样性背景或在交谈时身体不适）。通过线性回归发现，“污名化、诊断和风险”的差异可由参与临床医生是否接受过医学培训、他们处理严重心理健康问题的经验、处理困扰的信心以及对诊断的态度来显著解释。“个体情况”的差异可由参与临床医生处理困扰的信心来显著解释。支持诊断讨论的最常用策略集中在卫生专业人员的沟通技巧上，评估个体对自身情况的感知，以同理心回应，在讨论后跟进，解决污名化问题，采用协作实践并为对话做好准备。
结论
当与相关个体讨论消息时，卫生专业人员需要反思、计划和最终解决三个主要问题领域（“污名化、诊断和风险”；“服务结构”；以及“个体情况”）。实践中的差异表明，从业者应意识到自己的信念和背景，以及这如何影响他们的沟通实践。
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