Equity-based narratives in physician-family conversations about goals of care.

IF 1.2 4区 医学 Q3 FAMILY STUDIES
Andrew Childress, Woods Nash
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引用次数: 0

Abstract

Introduction: During conversations about the goals of care, clinicians sometimes use communication strategies that are inadequate for promoting shared decision making. Instead of jointly constructing an equity-based narrative of the patient's illness with the family, clinical care teams often treat the patient as if they are abstracted from their cultural, social, and family background. This approach to decision making fails to account for health inequities and cultural differences while reinforcing asymmetrical power dynamics that favor the health care team and institution.

Method: After reviewing the literature on health communication and health equity, we determined that language, particularly the use of metaphors, can reinforce systems of power that benefit clinical care teams, often at the expense of patients and their families.

Results: In this article, we offer a novel approach to these conversations that considers tensions between the frames of the dominant narrative of individualism used by clinicians who see a patient in abstraction from systems and an equity-based narrative that is concerned with those systems and their impacts on the patient.

Discussion: This article offers some guidance for clinicians on how to craft goals of care conversations in ways that are meaningful to patients and families while enhancing communication and promoting shared decision making. While this article focuses on a specific discussion about caring for a patient in the intensive care unit, the approach offered here could be applied to any goals of care conversation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

医生与家属关于护理目标的对话中基于公平的叙述。
在关于护理目标的对话中,临床医生有时使用不足以促进共同决策的沟通策略。临床护理团队往往把病人从他们的文化、社会和家庭背景中抽离出来,而不是与家人共同构建一个基于公平的病人疾病叙述。这种决策方法未能解释卫生不平等和文化差异,同时强化了有利于卫生保健团队和机构的不对称权力动态。方法:在回顾了有关健康沟通和健康公平的文献后,我们确定语言,特别是隐喻的使用,可以加强有利于临床护理团队的权力系统,通常以牺牲患者及其家属为代价。结果:在本文中,我们为这些对话提供了一种新颖的方法,该方法考虑了临床医生使用的个人主义主导叙事框架之间的紧张关系,这些临床医生从系统中抽象地看待患者,而基于公平的叙事则关注这些系统及其对患者的影响。讨论:本文为临床医生提供了一些指导,指导他们如何在加强沟通和促进共同决策的同时,以对患者和家属有意义的方式制定护理对话的目标。虽然本文关注的是关于在重症监护室照顾病人的具体讨论,但这里提供的方法可以应用于任何护理对话的目标。(PsycInfo Database Record (c) 2025 APA,版权所有)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Families Systems & Health
Families Systems & Health HEALTH CARE SCIENCES & SERVICES-PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
CiteScore
1.50
自引率
7.70%
发文量
81
审稿时长
>12 weeks
期刊介绍: Families, Systems, & Health publishes clinical research, training, and theoretical contributions in the areas of families and health, with particular focus on collaborative family healthcare.
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