Caldwell Karen L, Vicidomini Delia, Wells Reese, Wolever Ruth Q
Department of Human Development and Psychological Counseling, Appalachian State University, Boone, North Carolina.
Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee.
Glob Adv Health Med. 2020 Feb 12;9:2164956120904662. doi: 10.1177/2164956120904662. eCollection 2020.
While recent health-care trends rely on activated patients, few studies report direct observations of to engage and activate patients to be full participants in their own health care. The interpersonal processes and communication strategies used in integrative health coaching (IHC) may offer important insight into how clinicians can help patients step into a more active learning model rather than more typical passive roles.
This study uses verbatim transcripts of medical patients' first few IHC sessions to identify the actual processes used to help patients embrace this more active learning role.
A thematic analysis was conducted of 72 verbatim transcripts from IHC sessions of 26 patients with severe dysfunction from tinnitus. The patients participated in 6 months of IHC as part of a larger integrative intervention in a randomized, controlled pilot designed to assess feasibility for a larger randomized, controlled trial on the clinical effectiveness of an integrative intervention.
Four themes emerged: (1) Describing the Health Coaching Process to patients; (2) Using Key Procedures for Action Planning-optimal health future self-visualization, Wheel of Health, and exploration of the gap between current and desired states to help patients set goals for themselves; (3) Supporting Action and Building Momentum-the creation and support of action steps with frequent reinforcement of self-efficacy; and (4) Active Listening and Inviting the Patient to Articulate Learning-coaches' active listening process included reflection, clarifying questions, turning patient questions back to the patients, highlighting values, identifying potential barriers and resources, and inviting patients to articulate what they were learning.
The processes identified in IHC incorporate key principles of adult learning theory and engage patients' innate resources of goal orientation, self-direction, and intrinsic motivation. These interpersonal processes help patients embrace a more active learning role, with implications for patient engagement in other clinical contexts.
尽管近期的医疗保健趋势依赖于积极主动的患者，但很少有研究报告直接观察到如何促使和激励患者成为自身医疗保健的全面参与者。综合健康指导（IHC）中使用的人际过程和沟通策略可能为临床医生如何帮助患者步入更积极的学习模式而非更典型的被动角色提供重要见解。
本研究使用医疗患者最初几次IHC疗程的逐字记录稿，以确定帮助患者接受这种更积极学习角色所采用的实际过程。
对26名患有严重耳鸣功能障碍患者的IHC疗程的72份逐字记录稿进行了主题分析。作为一项更大规模综合干预的一部分，这些患者参加了为期6个月的IHC，该综合干预是一项随机对照试验，旨在评估一项关于综合干预临床效果的更大规模随机对照试验的可行性。
出现了四个主题：（1）向患者描述健康指导过程；（2）使用行动计划的关键程序——最佳健康未来自我可视化、健康轮以及探索当前状态与期望状态之间的差距，以帮助患者为自己设定目标；（3）支持行动并增强动力——创建并支持行动步骤，同时频繁强化自我效能感；（4）积极倾听并邀请患者阐述所学内容——指导者的积极倾听过程包括反思、澄清问题、将患者的问题抛回给患者、强调价值观、识别潜在障碍和资源，以及邀请患者阐述他们所学的内容。
IHC中确定的过程纳入了成人学习理论的关键原则，并调动了患者目标导向、自我指导和内在动机的内在资源。这些人际过程有助于患者接受更积极的学习角色，对患者在其他临床环境中的参与具有启示意义。
