处方前偏离:在初级保健中谈判阿片类药物和慢性疼痛
Anne Elizabeth Clark White1, Richard L Kravitz2,3, Stephen G Henry2,3
1The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego.
Health communication
|February 23, 2026
概括
医生经常在讨论治疗慢性疼痛的阿片类药物治疗之前使用许多"偏移"策略. 更多的这些沟通延迟与访问期间患者和医生的体验较差有关.
科学领域:
- 医学沟通 医学沟通
- 疼痛管理 疼痛管理
- 医疗服务研究 医疗服务研究
背景情况:
- 治疗慢性疼痛的阿片类药物治疗涉及复杂的患者与医生的沟通.
- 了解沟通动态对于有效的疼痛管理和患者满意度至关重要.
研究的目的:
- 检查慢性疼痛的初级保健访问中与阿片类药物相关的治疗谈判.
- 为了识别医生"偏移"的做法和沟通风格.
- 探索沟通模式与患者/医生访问经验之间的关联.
主要方法:
- 视频记录了慢性阿片类药物患者的86次初级保健访问.
- 利用对话分析来识别患者的要求和医生偏移策略.
- 采用了通用线性混合模型来分析沟通和经验之间的关联.
主要成果:
- 大多数患者 (96%) 使用间接请求来更好地控制疼痛.
- 医生在推治疗之前平均有67次"偏移".
- 偏移频率的增加与患者和医生访问体验的恶化有关.
结论:
- 医生在提出阿片类药物治疗建议之前进行了广泛的沟通工作.
- 特定的医生沟通风格和偏移实践会影响访问体验.
- 分析谈判实践可能会揭示改善阿片类药物相关讨论的策略.
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