Associate Professor and Chair in the Discipline of Family Medicine at Memorial University of Newfoundland in St John's.
Assistant Professor in the Centre for Studies in Family Medicine, the Department of Family Medicine, and the Department of Epidemiology and Biostatistics at the University of Western Ontario in London.
Can Fam Physician. 2018 Apr;64(Suppl 2):S63-S69.
To explore the process of the development of the patient-physician relationship in adult patients with severe or profound intellectual and developmental disabilities (IDD), from the perspective of the patients' caregivers.
Constructivist grounded theory.
St John's, NL.
Thirteen primary caregivers (5 males, 8 females) of 1 or more adults with severe or profound IDD.
Data were collected via in-depth, semistructured interviews conducted in person or by telephone. Interviews were audiorecorded and transcribed verbatim. Field notes were documented immediately by the interviewer and discussed with the research team. Memos in the form of reflective notes served as additional sources of data.
From the perspective of the caregivers, the core process in the development of the patient-physician relationship was protection. This process began as a result of the caregiver's recognition of the patient's vulnerability and moved through a number of stages before resulting in the development of a dynamic triangular interaction between the patient, caregiver, and family physician. First, the caregiver provides extreme nurturing to the patient, which results in the development of a strong bond between them. The patient and caregiver approached the family physician together as one unit, and then decided together on whether or not to open the patient-caregiver bond to the physician. The resultant dynamic triangular interaction formed the starting point from which 1 of 4 different relationship-development trajectories began. Which trajectory was taken and, therefore, the character of the relationships that developed was determined by how the caregiver and patient experienced their interaction with the family physician.
Findings highlight the process of protection and the centrality of the patient-caregiver bond within the development of a triadic relationship involving the patient with IDD, the caregiver, and the family physician. How a physician approaches this bond can influence the trajectory of the resulting relationship.
从患者照顾者的角度探讨成年严重或极重度智力和发育障碍（ID）患者医患关系发展的过程。
建构主义扎根理论。
NL 省圣约翰。
13 名严重或极重度 ID 患者的 1 名或多名成年患者的主要照顾者（5 男，8 女）。
通过面对面或电话进行深入的半结构化访谈收集数据。访谈进行录音并逐字记录。现场记录由访谈者立即记录，并与研究团队讨论。以反思性注释形式的备忘录作为额外的数据来源。
从照顾者的角度来看，医患关系发展的核心过程是保护。这一过程始于照顾者对患者脆弱性的认识，经历了几个阶段，最终导致患者、照顾者和家庭医生之间形成动态的三角互动。首先，照顾者对患者进行极度的养育，从而在他们之间建立了强烈的联系。患者和照顾者一起作为一个单位与家庭医生接触，然后共同决定是否将患者-照顾者关系向医生开放。由此形成的动态三角互动构成了 4 种不同关系发展轨迹中的 1 种的起点。照顾者和患者与家庭医生的互动体验决定了采用哪种轨迹，以及由此产生的关系的性质。
研究结果强调了保护过程以及在涉及 ID 患者、照顾者和家庭医生的三方关系发展中患者-照顾者关系的核心地位。医生如何处理这种关系可以影响到关系发展的轨迹。
