Miao Melissa, Dahm Maria R, Li Julie, Thomas Judith, Georgiou Andrew
Macquarie University, Sydney, NSW, Australia.
The University of Technology Sydney, Sydney, NSW, Australia.
Qual Health Res. 2020 Jul;30(8):1287-1300. doi: 10.1177/1049732320913037. Epub 2020 Apr 4.
We sought (a) an inductive understanding of patient and clinician perspectives and experiences of the communication of diagnostic test information and (b) a normative understanding of the management of uncertainty that occurs during the clinical encounter in emergency care. Between 2016 and 2018, 58 interviews were conducted with patients and nursing, medical, and managerial staff. Interview data were sequentially analyzed through an inductive thematic analysis, then a normative theory of uncertainty management. Themes of "Ideals," "Service Efficiency," and "Managing Uncertainty" were inductively identified as influencing the communication of diagnostic test information. A normative theory of uncertainty management highlighted (a) how these themes reflected the interaction's sociocultural context, encapsulated various criteria by which clinicians and patients evaluated the appropriateness and effectiveness of their communication, and represented competing goals during the clinical encounter, and (b) how systemic tensions between themes accounted for when diagnostic test information communication occurred, was deferred or avoided.
(a)对患者以及临床医生在诊断检查信息沟通方面的观点和经历进行归纳性理解;(b)对急诊护理临床问诊过程中出现的不确定性管理进行规范性理解。在2016年至2018年期间,我们对患者以及护理、医疗和管理人员进行了58次访谈。通过归纳主题分析,然后是不确定性管理的规范性理论,对访谈数据进行了顺序分析。归纳确定了“理想”、“服务效率”和“管理不确定性”等主题对诊断检查信息沟通产生影响。不确定性管理的规范性理论强调:(a)这些主题如何反映互动的社会文化背景,涵盖了临床医生和患者评估其沟通的适当性和有效性的各种标准,并代表了临床问诊过程中的相互竞争的目标;(b)主题之间的系统性紧张关系如何解释诊断检查信息沟通何时发生、被推迟或被避免。