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分道不立:疑难慢性病中患者与医疗服务提供者的协作

Divided We Stand: The Collaborative Work of Patients and Providers in an Enigmatic Chronic Disease.

作者信息

Pichon Adrienne, Schiffer Kayla, Horan Emma, Massey Bria, Bakken Suzanne, Mamykina Lena, Elhadad Noémie

机构信息

Columbia University, Department of Biomedical Informatics.

Columbia University, Barnard College.

出版信息

Proc ACM Hum Comput Interact. 2021 Jan;4(CSCW3). doi: 10.1145/3434170.

Abstract

In chronic conditions, patients and providers need support in understanding and managing illness over time. Focusing on endometriosis, an enigmatic chronic condition, we conducted interviews with specialists and focus groups with patients to elicit their work in care specifically pertaining to dealing with an enigmatic disease, both independently and in partnership, and how technology could support these efforts. We found that the work to care for the illness, including reflecting on the illness experience and planning for care, is significantly compounded by the complex nature of the disease: enigmatic condition means uncertainty and frustration in care and management; the multi-factorial and systemic features of endometriosis without any guidance to interpret them overwhelm patients and providers; the different temporal resolutions of this chronic condition confuse both patients and provides; and patients and providers negotiate medical knowledge and expertise in an attempt to align their perspectives. We note how this added complexity demands that patients and providers work together to find common ground and align perspectives, and propose three design opportunities (considerations to construct a holistic picture of the patient, design features to reflect and make sense of the illness, and opportunities and mechanisms to correct misalignments and plan for care) and implications to support patients and providers in their care work. Specifically, the enigmatic nature of endometriosis necessitates complementary approaches from human-centered computing and artificial intelligence, and thus opens a number of future research avenues.

摘要

在慢性病中,患者和医疗服务提供者需要长期的支持来理解和管理疾病。以子宫内膜异位症这种神秘的慢性病为例,我们采访了专家,并与患者进行了焦点小组讨论,以了解他们在独立和合作处理这种神秘疾病时的护理工作,以及技术如何支持这些努力。我们发现,由于疾病的复杂性,护理工作,包括对疾病经历的反思和护理规划,变得更加复杂:神秘的病症意味着护理和管理中的不确定性和挫败感;子宫内膜异位症的多因素和系统性特征,且没有任何指导来解读这些特征,使患者和医疗服务提供者不堪重负;这种慢性病不同的时间分辨率让患者和医疗服务提供者都感到困惑;患者和医疗服务提供者协商医学知识和专业技能,试图使他们的观点一致。我们指出,这种增加的复杂性要求患者和医疗服务提供者共同努力找到共同点并使观点一致,并提出了三个设计机会(构建患者整体情况的考虑因素、反映和理解疾病的设计特征,以及纠正不一致和规划护理的机会和机制)以及支持患者和医疗服务提供者护理工作的意义。具体而言,子宫内膜异位症的神秘性质需要以人为本的计算和人工智能的互补方法,从而开辟了许多未来的研究途径。

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