Department of Communication Studies, The University of Texas at Austin, Austin, Texas.
Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota.
Ann Fam Med. 2024 Nov-Dec;22(6):533-538. doi: 10.1370/afm.3177.
Unhurried conversations are necessary for careful and kind care that is responsive and responsible to both patients and clinicians. Adequate conceptual development is an important first step in being able to assess and measure this important domain of quality of care. In this article, we expand on a preliminary model to identify the key microlevel communication practices that support an unhurried conversation, defined as an ongoing, mutual accomplishment between patient and clinician that proceeds through a range of verbal and nonverbal communication practices wherein one or more participants (mutually) regulate the sequence, spacing (temporal and spatial), and speed of interaction to make themselves available to the other and remove or suspend distractions from the environment in order to improve care. We draw from the rich, qualitative descriptions found in earlier work that point to specific, observable practices in clinical encounters and identified empirical and theoretical work across a range of disciplines to expand our understanding of these practices. Ultimately, we identify and elaborate on 10 observable indicators of patient-clinician communication: engaging in shared turn taking, establishing rapport through discussion of off-task topics, pausing to allow the other ample time to speak, moderating the pace of spoken language, avoiding conversational interruptions, minimizing external interruptions, triaging topics as needed to create adequate time, expressing emotions, encouraging participation through inviting questions, and displaying open body language. These indicators work together to cocreate unhurried conversations.
从容的对话对于既对患者又对临床医生负责且关怀备至的精心护理是必要的。充分的概念发展是能够评估和衡量护理质量这一重要领域的重要第一步。在本文中，我们扩展了一个初步模型，以确定支持从容对话的关键微观沟通实践，将其定义为患者和临床医生之间持续的、相互的成就，通过一系列言语和非言语沟通实践进行，其中一个或多个参与者（相互）调节序列、间隔（时间和空间）和交互速度，以使自己对对方可用，并消除或暂停环境中的干扰，以改善护理。我们借鉴了早期工作中发现的丰富的定性描述，这些描述指向临床接触中的具体、可观察的实践，并确定了跨多个学科的实证和理论工作，以扩展我们对这些实践的理解。最终，我们确定并详细阐述了 10 个可观察的医患沟通指标：共同参与轮流发言、通过讨论非任务话题建立融洽关系、暂停以留出足够的时间让对方发言、调节口语语速、避免打断对话、尽量减少外部干扰、根据需要对话题进行分类以创造足够的时间、表达情感、通过邀请问题鼓励参与以及展示开放的肢体语言。这些指标共同创造了从容的对话。
