Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY, USA.
Patient Educ Couns. 2017 Jul;100(7):1345-1352. doi: 10.1016/j.pec.2017.02.022. Epub 2017 Feb 24.
We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter.
Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness.
Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it.
Teach-back was associated with more patient-centered communication and increased affective engagement of parents.
Standardizing Teach-back use may strengthen patient-centered communication.
我们提出并检验了一个关于反馈教学如何影响儿科临床就诊中沟通的理论框架。
对 44 名哮喘儿童进行了录音的儿科初级保健就诊，并使用 Roter 互动分析系统进行编码，以衡量以患者为中心的沟通和家长的情感投入。一个新创建的反馈循环评分衡量了在临床就诊期间反馈教学发生的程度；家长的健康素养通过最新生命体征进行测量。使用逻辑回归检验反馈教学与沟通特征之间的关系。分别与临床医生和家长进行焦点小组讨论，了解他们对反馈教学有用性的看法。
39%的就诊中使用了反馈教学。使用反馈教学的就诊中，以患者为中心的沟通更多（p=0.01）。调整家长健康素养、家长年龄和孩子年龄后，反馈教学增加了以患者为中心的沟通[比例优势比（95%置信区间）=4.97（4.47-5.53）]和负性情绪[优势比（95%置信区间）=5.39（1.68-17.31）]的可能性。临床医生和家长的焦点小组主题包括：反馈教学是有效的，可能会引起不适，应该用于儿童，护士应该使用它。
反馈教学与以患者为中心的沟通增加和家长的情感投入增加有关。
标准化反馈教学的使用可能会加强以患者为中心的沟通。
