Allen S, Harris R, Brown S L, Humphris G, Zhou Y, Rogers S N
Department of Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Room 111, 1st floor, Block B, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
Department of Health Services Research, Institute of Psychology Health and Society, Block B, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
Br J Oral Maxillofac Surg. 2018 Jul;56(6):536-539. doi: 10.1016/j.bjoms.2018.05.015. Epub 2018 Jun 13.
To examine associations between socioeconomic status and the extent to which patients with cancer of the head and neck expressed concerns to surgeons during routine follow-up clinics, we analysed audio recordings of 110 consultations with one consultant. We used the Verona Coding Definitions of Emotional Sequences (VRCoDES) to measure communication between the doctor and the patient, and grouped the English indices of multiple deprivation (IMD) 2015 scores into deciles to compare the VRCoDES with socioeconomic status. There were no significant correlations between IMD decile and the number and type of cues and concerns, or the type of response by the consultant, but there was a positive correlation between IMD decile and duration of appointment (r=0.288, p<0.01). When the duration of appointment was controlled for, there was a negative correlation between IMD decile and number of cues and concerns (r=-0.221, p<0.05). These findings question the assumption that socioeconomic status is associated with a patient's willingness to express concerns. Shorter consultations suggest that less time is spent responding to their concerns or building a rapport. Clinicians might find it advantageous to adopt strategies that will improve their understanding of these patients and help them to communicate more effectively.
为了研究社会经济地位与头颈癌患者在常规随访门诊中向外科医生表达担忧的程度之间的关联，我们分析了一位会诊医生的110次会诊的音频记录。我们使用情感序列的维罗纳编码定义（VRCoDES）来衡量医生与患者之间的沟通，并将2015年多重贫困指数（IMD）的英语指标分数分为十分位数，以比较VRCoDES与社会经济地位。IMD十分位数与线索和担忧的数量及类型，或会诊医生的反应类型之间没有显著相关性，但IMD十分位数与预约时长之间存在正相关（r = 0.288，p < 0.01）。当控制预约时长时，IMD十分位数与线索和担忧的数量之间存在负相关（r = -0.221，p < 0.05）。这些发现对社会经济地位与患者表达担忧的意愿相关这一假设提出了质疑。较短的会诊表明用于回应他们的担忧或建立融洽关系的时间较少。临床医生可能会发现采用能增进他们对这些患者的理解并帮助他们更有效沟通的策略是有益的。
