高危产前咨询中的沟通：对患者和产科医生之间互动的直接观察研究。
Communication in high risk ante-natal consultations: a direct observational study of interactions between patients and obstetricians.
机构信息
Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand.
Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand.
出版信息
BMC Pregnancy Childbirth. 2020 Aug 27;20(1):493. doi: 10.1186/s12884-020-03015-6.
BACKGROUND
Effective communication is crucial to any doctor-patient consultation, not least in pregnancy where the outcome affects more than one person. While higher levels of patient participation and shared decision making are recognised as desirable, there is little agreement on how best to achieve this. Most previous research in this area is based on reported data such as interviews or surveys and there is a need for more fine-grained analysis of authentic interaction. This study aimed to identify the discourse characteristics and patterns that exemplify effective communication practices in a high-risk ante-natal clinic.
METHODS
We video-recorded 20 consultations in a high-risk ante-natal clinic in a large New Zealand city with patients attending for the first time. Post-consultation interviews were conducted with the 20 patients and 13 obstetricians involved. Discourse analysis of the transcripts and videos of the consultations was conducted, in conjunction with thematic analysis of interview transcripts.
RESULTS
Most patients reported high quality communication and high levels of satisfaction; the detailed consultation analysis revealed a range of features likely to have contributed. On the clinician side, these included clear explanations, acknowledgement of the patient's experience, consideration of patient wishes, and realistic and honest answers to patient questions. On the patient side, these included a high level of engagement with technical aspects of events and procedures, and appropriate questioning of obstetricians.
CONCLUSIONS
This study has demonstrated the utility of combining direct observation of consultations with data from patient experience interviews to identify specific features of effective communication in routine obstetric ante-natal care. The findings are relevant to improvements needed in obstetric communication identified in the literature, especially in relation to handling psychosocial issues and conveying empathy, and may be useful to inform communication training for obstetricians. The presence of the unborn child may provide an added incentive for parents to develop their own health literacy and to be an active participant in the consultation on behalf of their child. The findings of this study can lay the groundwork for further, more detailed analysis of communication in ante-natal consultations.
背景
有效的沟通对于任何医患咨询都至关重要，尤其是在妊娠期间，因为其结果不仅影响一个人。尽管人们认识到更高水平的患者参与和共同决策是理想的，但对于如何最好地实现这一目标仍存在争议。该领域的大多数先前研究都是基于访谈或调查等报告数据进行的，因此需要对真实互动进行更精细的分析。本研究旨在确定能体现高危产前诊所有效沟通实践的话语特征和模式。
方法
我们在新西兰一个大城市的高危产前诊所录制了 20 次咨询的视频，患者首次就诊。对参与的 20 名患者和 13 名产科医生进行了咨询后的访谈。对咨询的文字记录和视频进行了话语分析，并结合对访谈文字记录的主题分析。
结果
大多数患者报告沟通质量高，满意度高；详细的咨询分析揭示了一系列可能促成这一结果的特征。在临床医生方面，这些特征包括清晰的解释、对患者经历的认可、考虑患者的意愿，以及对患者问题的现实和诚实的回答。在患者方面，这些特征包括对事件和程序的技术方面的高度参与，以及对产科医生的适当提问。
结论
本研究表明，将咨询的直接观察与患者体验访谈数据相结合，用于识别常规产科产前护理中有效沟通的具体特征是有用的。这些发现与文献中确定的产科沟通改进相关，尤其是在处理心理社会问题和表达同理心方面，也可能有助于为产科医生提供沟通培训。胎儿的存在可能为父母提高自身健康素养并代表孩子积极参与咨询提供额外的动力。本研究的结果可以为产前咨询中沟通的进一步、更详细的分析奠定基础。
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