Kushida Shuya, Hiramoto Takeshi, Yamakawa Yuriko
Osaka Kyoiku University.
Kyoto University.
Commun Med. 2016;13(2):169-184. doi: 10.1558/cam.27013.
In spite of increasing advocacy for patients' participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients' participation in treatment decision-making.
尽管越来越多的人倡导患者参与精神科决策，但关于患者在精神科会诊中实际如何参与决策的研究却很少。本研究探讨了日本门诊精神科会诊中患者如何在治疗决策中采取主动。我们采用会话分析方法，分析了85段正在进行的会诊视频记录，发现患者在采取主动进行决策时会在两种做法之间进行选择：明确要求某种治疗，以及在未明确要求的情况下表现出对某种治疗的兴趣。对转录互动的仔细检查表明，患者在认为候选治疗适合其病情的情况下会提出明确要求，而当他们不确定其适用性时，只会表现出对某种治疗的兴趣。通过将采取主动进行决策的做法与他们描述自身当前状况的方式相匹配，患者能够最佳地管理他们对特定治疗的渴望以及其主动行动的有效性。总之，我们认为有序地运用这两种做法是患者参与治疗决策的一项重要资源。
