City University of London, School of Health Sciences, Division of Health Sciences Research and Management, 1 Myddelton St, Clerkenwell, London, EC1R 1UB, UK.
Soc Sci Med. 2021 Dec;290:114082. doi: 10.1016/j.socscimed.2021.114082. Epub 2021 Jun 4.
People presenting to the emergency department with self-harm or thoughts of suicide undergo a psychosocial assessment involving recommendations for e.g. contact with other practitioners, charity helplines or coping strategies. In these assessments, patients frequently adopt a negative stance towards potential recommendations. Analysing 35 video-recorded liaison psychiatry psychosocial assessments from an emergency department in England (2018-2019), we ask how these practitioners transform this negative stance into acceptance. We show that practitioners use three steps to anticipate and address negative stance (1) asking questions about the patient's experience/understanding that help the patient to articulate a negative stance (e.g., "what do you think about that"); (2) accepting or validating the reasons underlying the negative stance (e.g., "that's a very real fear and thought to have"); and (3) showing the patient that their reasons were incorporated in the recommendation (e.g., "it's telephone support if you're a bit more uncomfortable with face to face"). These steps personalise the recommendation based on the patient's specific experiences and understanding. When practitioners followed all three of these steps, the patient moved from a negative stance to acceptance in 84% of cases. When practitioners made a recommendation but did not follow all three steps, the patient moved from a negative stance to acceptance in only 14% of cases. It is not the case that each communication practice works on its own to promote patient acceptance, rather Steps 1 and 2 build on each other sequentially to develop and demonstrate shared understanding of the patient's negative stance. In this way, acceptance and validation play an indispensable role in addressing a patient's concerns about treatment.
到急诊科就诊的自残或自杀意念患者会接受社会心理评估，包括与其他从业者、慈善热线或应对策略联系的建议。在这些评估中，患者经常对潜在的建议采取消极态度。通过分析英格兰一家急诊科（2018-2019 年）的 35 段视频记录联络精神病学社会心理评估，我们探讨了这些从业者如何将这种消极态度转变为接受。我们表明，从业者采用三个步骤来预测和解决消极态度：（1）询问患者的体验/理解，帮助患者表达消极态度（例如，“你对那个怎么看”）；（2）接受或验证消极态度背后的原因（例如，“这是一个非常真实的恐惧和想法”）；（3）向患者展示他们的原因已纳入建议（例如，“如果您对面对面交谈有点不舒服，这是电话支持”）。这些步骤基于患者的具体经验和理解使建议个性化。当从业者遵循这三个步骤时，84%的情况下患者会从消极态度转变为接受。当从业者提出建议但未遵循所有三个步骤时，只有 14%的情况下患者会从消极态度转变为接受。并非每个沟通实践都能独立促进患者接受治疗，而是步骤 1 和 2 相互衔接，逐步发展并展示患者对治疗的负面立场的共同理解。在这种方式下，接受和验证在解决患者对治疗的担忧方面起着不可或缺的作用。
