改善严重疾病沟通:临床文化的定性研究
Joanna Paladino1,2,3,4, Justin J Sanders5, Erik K Fromme6,7,8
1Massachusetts General Hospital, Boston, MA, USA. jpaladino@mgh.harvard.edu.
改善严重疾病的沟通需要解决临床文化的问题. 改变范式和赋予跨专业团队权力是尊重严重疾病对话中患者价值观和目标的关键.
科学领域:
- 提供医疗保健服务.
- 临床沟通 临床沟通
- 医学社会学 医学社会学
背景情况:
- 严重疾病沟通对于以人为中心的护理至关重要,但很难实现.
- 严重疾病护理计划的目的是改善这些跨卫生系统的对话.
研究的目的:
- 调查影响严重疾病沟通改善的临床培养因素.
- 识别实施严重疾病对话的促进者和障碍者.
主要方法:
- 半结构面试的定性分析.
- 与临床领导者,实施团队和前线冠军进行了30次采访.
- 包括来自息治疗,瘤学,初级保健和医院医学的参与者.
主要成果:
- 四个文化领域影响了沟通:临床范式,专业间赋权,感知对话影响和实践规范.
- 促进者包括转变的沟通范式,扩大角色的心理安全性,认识到对话的好处,并将讨论纳入常规流程.
- 抑制剂涉及到关于谈论死亡,以医生为中心的沟通,情绪不适以及缺乏可靠流程的对话的信念.
结论:
- 临床文化,特别是沟通范式和专业间赋权,显著影响了严重疾病沟通的采用.
- 需要进一步的研究来制定提高临床文化和推动实践变革的策略.
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