医患关系中的沟通模式：评估墨西哥低家长式作风相关的决定因素。
Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico.
作者信息
Lazcano-Ponce Eduardo, Angeles-Llerenas Angelica, Rodríguez-Valentín Rocío, Salvador-Carulla Luis, Domínguez-Esponda Rosalinda, Astudillo-García Claudia Iveth, Madrigal-de León Eduardo, Katz Gregorio
机构信息
Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
Centre for Mental Health Research, Australian National University, Canberra, Australia.
出版信息
BMC Med Ethics. 2020 Dec 10;21(1):125. doi: 10.1186/s12910-020-00566-3.
BACKGROUND
Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy.
METHODS
A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors.
RESULTS
A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed.
CONCLUSIONS
Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.
背景
家长式作风/过度保护限制了医疗保健专业人员与患者之间的沟通，不利于共同的治疗决策。在全球北方地区，沟通模式已得到规范以促进自主性，而在全球南方地区，沟通模式反映的是医生的个人选择。本研究的目的是增进对墨西哥临床实践中使用的沟通模式的了解，并确定有利于建立低家长式作风/自主性医患关系的决定因素。
方法
对墨西哥中部和西部761名精神卫生保健专业人员的样本进行了关于沟通模式的自我报告研究。使用多个有序逻辑回归模型分析家长式作风及相关因素。
结果
在墨西哥的精神卫生专业人员中观察到家长式作风的高流行率（68.7% [95%置信区间60.0 - 70.5]）。低家长式作风/自主性的主要决定因素是医学专业（比值比1.67 [95%置信区间1.16 - 2.40]）和性别，女医生更有可能与患者及其家属明确分享诊断结果和治疗策略（比值比1.57 [95%置信区间1.11 - 2.22]）。高度明确的沟通模式与低家长式作风/自主性密切相关（比值比12.13 [95%置信区间7.71 - 19.05]）。最后，观察到年龄层对沟通模式或专业与低家长式作风/自主性之间的关联有调节作用。
结论
在墨西哥的精神卫生专业人员中，高家长式作风普遍存在。性别、专业和开放沟通模式与低家长式作风/自主性密切相关。加强卫生专业人员的能力并促进明确沟通有助于墨西哥临床实践向更自主的沟通转变。伦理问题在不久的将来需要得到解决。
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