Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Patient Educ Couns. 2020 Apr;103(4):734-740. doi: 10.1016/j.pec.2019.10.020. Epub 2019 Oct 30.
Effective communication is integral to patient-centered care, yet external pressures can impede the ability to discuss important topics. One strategy to facilitate communication is pre-visit collection and sharing of patient contextual data (PCD), including life circumstances such as their beliefs, needs, and concerns.
To understand how patients and care team members perceive the electronic collection of PCD and its impact on communication in the context of a large academic health system that implemented PatientWisdom, a new technology that elicits PCD from patients and integrates within the electronic health record (EHR).
We conducted focus groups with patients (n = 26) and semi-structured interviews with primary care team members (n = 20). Qualitative analysis of focus group/interviews included an iterative and reflexive inductive technique to uncover emergent themes.
Four themes were reflected among both patient and care team: (1) the technology enhances the patient's voice; (2) the technology creates a safe space for patients to share sensitive topics; (3) PCD facilitates rapport not only between patient and provider but the entire care team; (4) PCD aligns patient and clinician goals. Two unique themes emerged among patients: (1) PCD provides opportunity for reflection; (2) PCD humanizes patients in the clinical context. One theme was evident in provider comments: collecting PCD may potentially undermine trust if not reviewed by clinical teams.
PCD collected directly from patients and available within the EHR was seen by patients and care team members as beneficial to communication. PCD collection supports a paradigm shift towards coproduction of health information and a shared responsibility for information gathering but requires investment from patients and care team to ensure the data are effectively utilized.
PCD may be useful for team-based care, enabling physicians and non-physician staff to more quickly and responsively connect with patients.
有效的沟通是患者为中心的护理的重要组成部分，但外部压力会阻碍讨论重要话题的能力。促进沟通的一种策略是在访问前收集和共享患者背景数据（PCD），包括他们的信仰、需求和关注点等生活情况。
了解患者和护理团队成员如何看待在大型学术医疗系统中使用 PatientWisdom 收集 PCD，以及该技术如何影响沟通。PatientWisdom 是一种新技术，可以从患者那里收集 PCD，并整合到电子健康记录（EHR）中。
我们对患者（n=26）进行了焦点小组讨论，并对初级保健团队成员（n=20）进行了半结构化访谈。对焦点小组/访谈的定性分析包括一种迭代和反思性的归纳技术，以揭示新出现的主题。
患者和护理团队都反映出四个主题：（1）该技术增强了患者的话语权；（2）该技术为患者分享敏感话题创造了安全空间；（3）PCD 不仅促进了医患关系，还促进了整个护理团队的关系；（4）PCD 使患者和临床医生的目标保持一致。患者中出现了两个独特的主题：（1）PCD 为患者提供了反思的机会；（2）PCD 在临床环境中使患者人性化。在提供者的评论中出现了一个主题：如果临床团队不审查 PCD，可能会破坏信任。
患者直接提供并在 EHR 中可用的 PCD 被患者和护理团队成员视为对沟通有益。PCD 的收集支持了健康信息共同生产和信息收集共同责任的范式转变，但需要患者和护理团队的投入，以确保数据得到有效利用。
PCD 可能对团队为基础的护理有用，使医生和非医生工作人员能够更快速和响应地与患者建立联系。
