What is said, meant, heard: Practitioner-patient understanding during delivery of diagnoses in the emergency department

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling Pub Date : 2026-04-01 Epub Date: 2026-01-16 DOI:10.1016/j.pec.2026.109490

Sarah N. Fuller, Lourah M. Kelly, Lukas A. McNaboe, Xenia G. Bradley, Charlotte J. Winkler, Caroline E. Wolek, Amber L. Wilkes, Patrick C. Bogui, Perpetual E. Taylor, Geetha R. Nichanametla, David P. Patrick, Matthew Babcock

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引用次数: 0

Abstract

Background

Effective communication between patients and practitioners is essential for patient satisfaction, adherence to the medical plan, and improved health outcomes. Delivering a diagnosis is a necessary component of patient care in the emergency department; however, these conversations can have risk for misunderstandings. This study investigated patient understanding of a new diagnosis in the emergency department and factors that modified this understanding.

Methods

Patients and practitioners completed surveys following delivery of a new diagnosis, and descriptions of the diagnosis by both parties were compared and graded for agreement by three external physicians. We examined whether the severity of diagnosis or adhering to a communication framework class influenced patient-practitioner agreement on the new diagnosis.

Results

Among 196 encounters, 83.7 % described the same diagnosis given by their practitioner (patient-practitioner agreement). Patient-practitioner agreement was correlated with the patient’s full understanding of their diagnosis (r = .17). Patient and practitioner-rated medical severity were inversely related (ρ=-.39). Practitioner-rated illness severity was related to difficulty receiving the diagnosis (ρ=-.38), difficulty delivering the diagnosis (ρ=.18), and adherence to a communication protocol (ρ=-.16). Multivariable Poisson regressions showed significantly increased practitioner-patient agreement on the new diagnosis when the patient self-reported full understanding of the diagnosis (RR=1.18, p < .05), and significantly decreased practitioner-patient agreement within certain diagnostic classes, specifically cardiac (RR=.71, p < .05) and gastrointestinal (RR=.77, p < .05) relative to musculoskeletal diagnoses.

Conclusion

Most patients correctly described a new diagnosis given in the emergency department. However, in cases with misunderstanding, patients were significantly less likely to correctly describe a new diagnosis when they received cardiac and gastrointestinal diagnoses and when they reported anything less than full understanding.

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所说、所指、所闻：在急诊科诊断过程中医患之间的理解

背景：患者和医生之间的有效沟通对于患者满意度、医疗计划的依从性和改善健康结果至关重要。提供诊断是急诊科病人护理的必要组成部分；然而，这些对话也有产生误解的风险。本研究调查了患者对急诊科新诊断的理解以及改变这种理解的因素。方法患者和执业医师在提供新诊断后完成问卷调查，比较双方对诊断的描述，并由三位外部医生进行评分。我们检查了诊断的严重程度或坚持沟通框架类是否影响患者-医生对新诊断的协议。结果在196次就诊中，83.7 %描述了其医生给出的相同诊断（医患一致）。医患协议与患者对诊断的充分理解相关（r = .17）。患者和医生评定的医疗严重程度呈负相关（ρ=- 0.39）。医生评定的疾病严重程度与难以接受诊断（ρ=- 0.38）、难以传达诊断（ρ= 0.18）和遵守沟通协议（ρ=- 0.16）有关。多变量泊松回归显示，当患者自我报告完全理解诊断时，医患对新诊断的一致性显著增加（RR=1.18, p <； ）。在某些诊断类别中，特别是心脏诊断类别，医患一致性显著降低（RR= 0.71, p <； ）。05)和胃肠道（RR= 0.77, p <； ）。05)相对于肌肉骨骼的诊断。结论大多数患者正确描述了急诊科的新诊断。然而，在有误解的情况下，当患者接受心脏和胃肠道诊断时，以及当他们报告任何不完全理解时，患者正确描述新诊断的可能性显著降低。

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

Patient Education and Counseling 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.60

自引率

11.40%

发文量

384

审稿时长

46 days

期刊介绍： Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.