Stenov Vibeke, Hempler Nana Folmann, Reventlow Susanne, Wind Gitte
Health Promotion, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Scand J Caring Sci. 2018 Jun;32(2):783-792. doi: 10.1111/scs.12509. Epub 2017 Aug 22.
To investigate approaches among healthcare providers (HCPs) that support or hinder person-centredness in group-based diabetes education programmes targeting persons with type 2 diabetes.
Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes included 21 participants and 10 HCPs and were observed over 5 weeks. Additionally, 10 in-depth semi-structured interviews were conducted with patients (n = 7) and HCPs (n = 3). Data were analysed using systematic text condensation.
Hindering approaches included a teacher-centred focus on delivering disease-specific information. Communication was dialog based, but HCPs primarily asked closed-ended questions with one correct answer. Additional hindering approaches included ignoring participants with suboptimal health behaviours and a tendency to moralize that resulted in feelings of guilt among participants. Supporting approaches included letting participants set the agenda using broad, open-ended questions.
Healthcare providers are often socialized into a biomedical approach and trained to be experts. However, person-centredness involves redefined roles and responsibilities. Applying person-centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person-centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person-centred approaches in a group context.
Teacher-centredness undermined person-centredness because HCPs primarily delivered disease-specific recommendations, leading to biomedical information overload for participants.
探讨医疗服务提供者（HCPs）在针对2型糖尿病患者的小组糖尿病教育项目中支持或阻碍以患者为中心的方法。
在丹麦的一个市政机构和一家医院进行人种志实地调查。这两个项目包括21名参与者和10名医疗服务提供者，观察期为5周。此外，还对患者（n = 7）和医疗服务提供者（n = 3）进行了10次深入的半结构化访谈。使用系统文本浓缩法对数据进行分析。
阻碍性方法包括以教师为中心，专注于提供特定疾病信息。沟通基于对话，但医疗服务提供者主要问有一个正确答案的封闭式问题。其他阻碍性方法包括忽视健康行为欠佳的参与者以及一种说教倾向，这导致参与者产生内疚感。支持性方法包括通过宽泛的开放式问题让参与者设定议程。
医疗服务提供者常常被社会化成采用生物医学方法，并被训练成为专家。然而，以患者为中心涉及重新定义角色和责任。在实践中应用以患者为中心的方法需要持续培训和监督，但医疗服务提供者在培养以患者为中心的沟通技巧方面往往得到的支持最少。基于动机沟通、心理社会方法和促进小组进程的技术是在小组环境中有效的以患者为中心的方法。
以教师为中心破坏了以患者为中心，因为医疗服务提供者主要提供特定疾病的建议，导致参与者生物医学信息过载。
