Kong Menglei, Wang Yu, Li Meixuan, Yao Zhong
School of Economics and Management, Beihang University, Beijing, China.
School of Public Health, Capital Medical University, Beijing, China.
J Med Internet Res. 2025 Mar 19;27:e54516. doi: 10.2196/54516.
Online health platforms are currently experiencing significant growth. Patients can conveniently seek medical consulting services on such platforms. Against the backdrop of the thriving development of digital health care, the patterns of physician-patient communication are undergoing profound changes. It is imperative to focus on physician discourse strategies during online physician-patient interactions, which will improve the efficiency of physician-patient communication and achieve better management of the physician-patient relationship.
This study aims to explore the influencing mechanism between physician discourse strategies and patient consultation behavior on online health platforms. Additionally, we explore the crucial mediating role of online physician-patient trust and the moderating role of shared decision-making in the online physician-patient communication process.
We used a mixed research approach to explore the influencing mechanism. Data on physician basic attributes and physician-patient communication text records were collected from the Chunyu Doctor website using a web spider. The study obtained a total of 8628 interaction texts from January 2022 to July 2023. Physician discourse strategies (capacity-oriented strategy, quality-oriented strategy, and goodwill-oriented strategy), online physician-patient trust, and shared decision-making were captured through text mining and a random forest model. First, we employed text mining to extract the speech acts, modal resources, and special linguistic resources of each record. Then, using a well-trained random forest model, we captured the specific discourse strategy of each interaction text based on the learned features and patterns. The study generated 863 groups of physician samples with 17 data fields. The hypotheses were tested using an "ordinary least squares" model, and a stability test was conducted by replacing the dependent variable.
The capacity-oriented strategy, goodwill-oriented strategy, and quality-oriented strategy had significant effects on patient consultation behavior (β=.151, P=.007; β=.154, P<.001; and β=.17, P<.001, respectively). It should be noted that the anticipated strong effect of the capacity-oriented strategy on patient consultation behavior was not observed. Instead, the effects of the quality-oriented strategy and goodwill-oriented strategy were more prominent. Physician notification adequacy from shared decision-making moderated the effect between the goodwill-oriented strategy and patient consultation behavior (β=.172; P<.001). Additionally, patient expression adequacy from shared decision-making moderated the effect between the capacity-oriented strategy and patient consultation behavior (β=.124; P<.001), and between the goodwill-oriented strategy and patient consultation behavior (β=.104; P=.003). Online physician-patient trust played a significant mediating role between physician discourse strategies and patient consultation behavior.
The study findings suggest significant implications for stimulating patient consultation behavior on online health platforms by providing guidance on effective discourse strategies for physicians, thus constructing a trustworthy physician image, improving the physician-patient relationship, and increasing platform traffic.
在线健康平台目前正在经历显著增长。患者可以在此类平台上方便地寻求医疗咨询服务。在数字医疗蓬勃发展的背景下，医患沟通模式正在发生深刻变化。在在线医患互动过程中关注医生的话语策略势在必行，这将提高医患沟通效率并实现对医患关系的更好管理。
本研究旨在探讨在线健康平台上医生话语策略与患者咨询行为之间的影响机制。此外，我们还探讨了在线医患信任的关键中介作用以及共同决策在在线医患沟通过程中的调节作用。
我们采用混合研究方法来探索影响机制。使用网络爬虫从春雨医生网站收集医生基本属性和医患沟通文本记录的数据。该研究共获取了2022年1月至2023年7月的8628条互动文本。通过文本挖掘和随机森林模型获取医生话语策略（能力导向策略、质量导向策略和善意导向策略）、在线医患信任和共同决策。首先，我们采用文本挖掘提取每条记录的言语行为、情态资源和特殊语言资源。然后，使用经过良好训练的随机森林模型，根据所学特征和模式捕捉每条互动文本的具体话语策略。该研究生成了863组具有17个数据字段的医生样本。使用“普通最小二乘法”模型对假设进行检验，并通过替换因变量进行稳定性检验。
能力导向策略、善意导向策略和质量导向策略对患者咨询行为有显著影响（β = 0.151，P = 0.007；β = 0.154，P < 0.001；β = 0.17，P < 0.001，分别）。需要注意的是，未观察到能力导向策略对患者咨询行为预期的强烈影响。相反，质量导向策略和善意导向策略的影响更为突出。共同决策中的医生告知充分性调节了善意导向策略与患者咨询行为之间的影响（β = 了0.172；P < 0.001）。此外，共同决策中的患者表达充分性调节了能力导向策略与患者咨询行为之间的影响（β = 0.124；P < 0.001），以及善意导向策略与患者咨询行为之间的影响（β = 0.104；P = 0.003）。在线医患信任在医生话语策略与患者咨询行为之间发挥了显著的中介作用。
研究结果表明，通过为医生提供有效话语策略的指导，对刺激在线健康平台上的患者咨询行为具有重要意义，从而构建可信赖的医生形象，改善医患关系，并增加平台流量。
