Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA.
Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, USA.
J Gen Intern Med. 2019 Jul;34(7):1139-1145. doi: 10.1007/s11606-019-04911-0. Epub 2019 Mar 18.
Patient-centered care for people with disability requires effective communication and compliance with the Americans with Disabilities Act (ADA).
To understand physicians' perspectives on communication experiences with people with disability.
Twenty semi-structured individual interviews. Interview recordings were transcribed verbatim for analysis.
Massachusetts, October 2017-January 2018.
Twenty physicians ranging from 8 to 51 years in practice in primary care or 4 other specialties.
Commonly expressed themes around communication with people with disability.
Concerns coalesced around 4 broad categories: communication experiences with people who are deaf or hard of hearing, communication with people who are blind or have vision impairment, communication with people who have intellectual disability, and recommendations for improving communication. Although participants in this study reported various efforts to communicate effectively with patients with hearing or vision loss or intellectual disability, many gaps appear to remain, as well as instances where physicians' preferences run counter to patients' wishes and the ADA. Examples include physicians' preferences for remote, online sign language interpreters despite patients desiring in-person interpreters and suggesting that patients arrange for their own interpreters. Few educational materials are available in braille, and electronic medical records may not allow documents to be printed in large font for persons with low vision. Communicating with patients with intellectual disability raised particular concerns, with participants often preferring to interact with caregivers and minimal efforts to involve patients.
Effective communication is necessary for ensuring the quality of health care for people with disability, and it is legally required under the ADA. Our results suggest that important gaps may remain in ensuring effective communication, and some practicing physicians could benefit from formal training in effective methods for communicating with patients with disability.
为残疾患者提供以患者为中心的护理需要有效的沟通，并遵守《美国残疾人法案》（ADA）。
了解医生与残疾患者沟通的经验。
20 次半结构式个体访谈。访谈录音逐字转录进行分析。
马萨诸塞州，2017 年 10 月至 2018 年 1 月。
20 名医生，从业年限从 8 年到 51 年不等，分别在初级保健或其他 4 个专业领域工作。
围绕与残疾患者沟通的常见主题。
关注点集中在 4 个广泛的类别：与聋哑人或听力障碍者的沟通、与视障或视力受损者的沟通、与智力残疾者的沟通，以及改善沟通的建议。尽管本研究的参与者报告了各种努力，以与听力或视力丧失或智力残疾患者有效沟通，但似乎仍存在许多差距，并且医生的偏好与患者的意愿和 ADA 相悖的情况也时有发生。例如，医生倾向于使用远程在线手语翻译，尽管患者希望有现场口译员，并建议患者自行安排口译员。很少有盲文教育材料，电子病历可能不允许为视力低下的人打印大字体的文件。与智力残疾患者沟通引起了特别关注，参与者通常更愿意与照顾者互动，而很少努力让患者参与。
有效的沟通对于确保残疾患者的医疗质量是必要的，并且根据 ADA 的要求，这在法律上也是必需的。我们的研究结果表明，在确保有效沟通方面可能仍存在重要差距，一些执业医生可能需要接受与残疾患者有效沟通的方法的正式培训。
