全科医疗中对情感问题的处理：全科医生会诊的主题分析

Engagement with emotional concerns in general practice: a thematic analysis of GP consultations.

作者信息

Nerurkar Louis, van der Scheer Iris, Stevenson Fiona

机构信息

University College London, Research Department for Primary Care Research and Population Health, London, UK.

University College London, Research Department for Primary Care Research and Population Health, London, UK

出版信息

BJGP Open. 2024 Apr 25;8(1). doi: 10.3399/BJGPO.2023.0202. Print 2024 Apr.

DOI:10.3399/BJGPO.2023.0202

PMID:37940141

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11169977/

Abstract

BACKGROUND

Emotional concerns (defined as any expression of low mood, anxiety, or psychosocial stress) are an important part of the biopsychosocial care model used in modern medical practice. Previous work has demonstrated variable engagement with emotional concerns and that improved communication has been associated with reductions in emotional distress.

AIM

To examine how emotional concerns are engaged with during routine GP consultations.

DESIGN & SETTING: Secondary study using the Harnessing Resources from the Internet (HaRI) database. The available dataset contains 231 recordings from 10 GPs across eight urban and suburban practices recorded in 2017 and 2018.

METHOD

The dataset was reviewed to identify any consultations containing emotional concerns (as defined as any expression of low mood, anxiety, or psychosocial stress) before being imported into NVivo (version 12) to facilitate thematic analysis and coding. Reflexive inductive thematic analysis resulted in two major themes.

RESULTS

The two main themes were as follows: engagement with emotional concerns as dynamic throughout consultations; and GPs engage with emotional concerns both diagnostically and therapeutically. In theme 1, this dynamism relates to competing areas of focus, immediate versus delayed engagement and reiteration of concerns throughout consultations. Emotional concerns can be engaged with in a similar way to physical concerns (theme 2) using a diagnostic and treatment-based approach; however, in addition to this, therapeutic listening and conversation is utilised.

CONCLUSION

Awareness of the dynamic nature of emotional concerns within consultations and encouraging engagement with concerns in a flexible and patient-oriented manner may help improve doctor-patient communication. In addition, investigating how GPs and patients build shared understanding around emotional concerns may identify methods to reduce patients' emotional distress.

摘要

背景

情绪问题（定义为情绪低落、焦虑或心理社会压力的任何表现）是现代医疗实践中使用的生物心理社会护理模式的重要组成部分。先前的研究表明，对情绪问题的关注程度存在差异，并且改善沟通与情绪困扰的减少有关。

目的

研究在全科医生常规会诊过程中如何处理情绪问题。

设计与背景

利用互联网资源（HaRI）数据库进行的二次研究。现有数据集包含2017年和2018年在8个城市和郊区诊所的10位全科医生的231份会诊记录。

方法

在将数据集导入NVivo（版本12）以促进主题分析和编码之前，对其进行审查以识别任何包含情绪问题（定义为情绪低落、焦虑或心理社会压力的任何表现）的会诊。反思性归纳主题分析产生了两个主要主题。

结果

两个主要主题如下：在整个会诊过程中，对情绪问题的关注是动态的；全科医生在诊断和治疗方面都关注情绪问题。在主题1中，这种动态性涉及相互竞争的关注领域、即时与延迟关注以及在整个会诊过程中对问题的反复提及。情绪问题可以通过基于诊断和治疗的方法，以与身体问题类似的方式得到关注（主题2）；然而，除此之外，还会运用治疗性倾听和对话。