Bright F A S, Reeves B
School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
School of Medicine, University of Auckland, Auckland, New Zealand.
Disabil Rehabil. 2022 Jun;44(12):2670-2682. doi: 10.1080/09638288.2020.1849419. Epub 2020 Nov 23.
Communication between patients and clinicians influences the development of therapeutic relationships. Communication is disrupted when the patient has communication impairments after stroke. However, how these communication disruptions influence therapeutic relationships is not well-understood. This qualitative metasynthesis explores the perspectives of people with communication impairment to understand how interpersonal communication influences therapeutic relationships.
Four databases were searched for qualitative studies which discussed how communication influenced therapeutic relationships from the perspectives of people with aphasia, dysarthria or apraxia of speech. Additional papers were identified through citation searching and subject experts. Nineteen eligible papers were included and analysed using thematic analysis.
Four themes were constructed from the analysis: (1) Relationships provide the foundation for rehabilitation; (2) Different relational possibilities arise from "reading" the clinician; (3) Creating therapeutic relationships through validating interactions and connections; and (4) Creating therapeutic disconnections through invalidating, exclusionary interactions.
A therapeutic relationship develops, at least in part, in response to the clinician's communication and how this is received and experienced by the patient. Understanding the characteristics of relationship-fostering communication and knowing how communication influences relationships can help clinicians critically reflect on their communication and better develop therapeutic relationships with people with communication impairment.IMPLICATIONS FOR REHABILITATIONPractitioner-patient communication can facilitate therapeutic relationships or create therapeutic disconnections.Communication patterns that are commonly evident when a patient has communication impairments can impede therapeutic relationships.Clinicians need to attend to how their communication is received and how it influences people's sense of self.Communication partner training should address the existential and relational needs of people with communication impairment after stroke.
患者与临床医生之间的沟通会影响治疗关系的发展。中风后患者出现沟通障碍时，沟通就会受到干扰。然而，这些沟通干扰如何影响治疗关系尚不清楚。这项定性元综合研究探讨了有沟通障碍者的观点，以了解人际沟通如何影响治疗关系。
检索了四个数据库，查找从失语症、构音障碍或言语失用症患者的角度讨论沟通如何影响治疗关系的定性研究。通过引文检索和专家鉴定确定了其他论文。纳入了19篇符合条件的论文，并使用主题分析法进行分析。
分析得出了四个主题：（1）关系为康复奠定基础；（2）通过“解读”临床医生产生不同的关系可能性；（3）通过有效的互动和联系建立治疗关系；（4）通过无效的、排他性的互动造成治疗关系的脱节。
治疗关系的发展至少部分取决于临床医生的沟通方式以及患者如何接受和体验这种沟通。了解促进关系的沟通特征以及沟通如何影响关系，有助于临床医生批判性地反思自己的沟通方式，更好地与有沟通障碍的患者建立治疗关系。
对康复的启示
医患沟通可以促进治疗关系，也可能造成治疗关系的脱节。
患者有沟通障碍时常见的沟通模式会阻碍治疗关系。
临床医生需要关注患者如何接受他们的沟通以及这种沟通如何影响患者的自我认知。
沟通伙伴培训应满足中风后有沟通障碍者的生存和关系需求。
