Communication and Medicine最新文献_第10页

A rejoinder to ‘Concepts of health, ethics, and communication in shared decision making’ by Lauris Kaldjian 对Lauris Kaldjian的“共同决策中的健康、伦理和沟通概念”的回应

Communication and Medicine Pub Date : 2018-10-26 DOI: 10.1558/CAM.36372

A. Clarke

引用次数: 0

The road not taken: Forgoing disease-directed treatments in advanced cancer. A rejoinder to ‘Concepts of health, ethics, and communication in shared decision making’ by Lauris Kaldjian 没有走的路:放弃针对晚期癌症的疾病治疗。对Lauris Kaldjian的“共同决策中的健康、伦理和沟通概念”的回应

Communication and Medicine Pub Date : 2018-10-26 DOI: 10.1558/CAM.36371

L. Cripe, R. Frankel

{"title":"The road not taken: Forgoing disease-directed treatments in advanced cancer. A rejoinder to ‘Concepts of health, ethics, and communication in shared decision making’ by Lauris Kaldjian","authors":"L. Cripe, R. Frankel","doi":"10.1558/CAM.36371","DOIUrl":"https://doi.org/10.1558/CAM.36371","url":null,"abstract":"Between 1961 and 1979 physicians changed their practice from most often not telling patients their diagnoses of cancer to routinely disclosing it (Oken 1961; Novack et al. 1979). The change can be explained, in large part, by advances in cancer treatment, growing appreciation of the duty to obtain informed consent, changes in professional values, and the rise of the patients’ rights movement. It soon became apparent, however, that patients with advanced cancer were often unaware of their prognoses because prognostic disclosure was far more challenging to physicians than diagnostic disclosure. In 1995, investigators of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) reported that an intervention to inform physicians of prognostic estimates and a nurse to elicit patient preferences and encourage patient–physician communication did not improve the frequency of code status discussions, physician awareness of patient resuscitation preferences, or number of days in the intensive care unit (ICU) (Connors 1995). In reflecting on the progress between the publication of the SUPPORT study and the 2015 Institute of Medicine report Improving Quality and Honoring Individual Preferences near the End of Life, we wondered whether the persistent concerns about the quality of end-of-life (EOL) care and patient awareness of prognosis are due to flaws in clinician appreciation of the ethical principles of informed/shared decision making or clinician communication skills.","PeriodicalId":39728,"journal":{"name":"Communication and Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83442053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations 在自然环境中，共同决策是什么样子的?病人与医生对话的混合方法研究

Communication and Medicine Pub Date : 2018-10-26 DOI: 10.1558/CAM.32815

J. Lee, W. Callon, C. Haywood, S. Lanzkron, P. Gulbrandsen, M. Beach

{"title":"What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations","authors":"J. Lee, W. Callon, C. Haywood, S. Lanzkron, P. Gulbrandsen, M. Beach","doi":"10.1558/CAM.32815","DOIUrl":"https://doi.org/10.1558/CAM.32815","url":null,"abstract":"Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits.","PeriodicalId":39728,"journal":{"name":"Communication and Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78732815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

The third speaker: The body as interlocutor in conventional, complementary, and integrative medicine encounters 第三位发言者:身体作为传统、补充和综合医学接触中的对话者

Communication and Medicine Pub Date : 2018-10-26 DOI: 10.1558/CAM.32577

Sonya E. Pritzker, Jennifer R. Guzmán, K. Hui, Derjung M. Tarn

{"title":"The third speaker: The body as interlocutor in conventional, complementary, and integrative medicine encounters","authors":"Sonya E. Pritzker, Jennifer R. Guzmán, K. Hui, Derjung M. Tarn","doi":"10.1558/CAM.32577","DOIUrl":"https://doi.org/10.1558/CAM.32577","url":null,"abstract":"This paper examines talk about the body in interactions between patients and their complementary/ alternative providers (CAM), integrative physicians (IM), or conventional physicians. In an analysis of 603 consultations, we focus on instances where the body is spoken of in agentive terms. We thus examine particular micro-interactive moments where the body is constituted as an agent that speaks, responds, and otherwise acts in ways that direct the flow of conversation or the medical decision-making process. With this data, we demonstrate how body-as-agent metaphors in the clinical encounter underscore the communicative agency of providers and position the body as an interlocutor or ‘third speaker’ in conversation with the patient and provider. We further note that we found only limited differences in the ways body-as-agent metaphors were used by CAM/IM and conventional providers. Rather than arguing that such differences demonstrate a fundamental divide between CAM/IM and conventional approaches, we therefore suggest that these kinds of supportive body-as-agent talk exist as opportunities for all providers to support patients in taking a more active stance in managing their relationship with their body.","PeriodicalId":39728,"journal":{"name":"Communication and Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84823920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Inter-organisational use of the electronic health record in mental health 电子健康记录在精神健康领域的跨组织使用

Communication and Medicine Pub Date : 2018-07-03 DOI: 10.1558/cam.32398

J. Räsänen, Kirsi Günther

{"title":"Inter-organisational use of the electronic health record in mental health","authors":"J. Räsänen, Kirsi Günther","doi":"10.1558/cam.32398","DOIUrl":"https://doi.org/10.1558/cam.32398","url":null,"abstract":"The creation and use of electronic records in welfare services is a subject that has received widespread attention. The electronic health record (EHR) is used by different stakeholders (NGOs, hospitals, health care clinics and commissioning agencies) and thus enables the distribution and sharing of recorded information between them, and in this article we focus on the tensions that arise from the inter-organisational use of the EHR in the context of mental health services. The data corpus consists of four focus group interviews from three NGOs in Finland, and we draw on ethnomethodology to analyse the ways in which mental health workers together talk and make sense of these tensions in their interview talk. Our findings suggest that the EHR addresses concerns about the dislocation of clients and continuity of care, which create a need for mental health workers to trace clients' service use and also the contributions by other professionals. However, the introduction of the EHR has increased the recording work of mental health workers as well as of the monitoring of their work performance. Our findings strengthen the case for more transparent practices and rules of recording and information sharing among the different users of the EHR.","PeriodicalId":39728,"journal":{"name":"Communication and Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80427050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

In support of goals-of-care discussions in shared decision making – An extended response to the rejoinders 支持共同决策中的护理目标讨论-对答复的扩展回应

Communication and Medicine Pub Date : 2018-04-25 DOI: 10.1558/CAM.36373

L. Kaldjian

引用次数: 3

Shared decision or decision shared? Interactional trajectories in Huntington’s disease management clinics 共同决策还是共同决策?亨廷顿氏病管理诊所的相互作用轨迹

Communication and Medicine Pub Date : 2018-01-05 DOI: 10.1558/CAM.36402

D. Duffin, S. Sarangi

{"title":"Shared decision or decision shared? Interactional trajectories in Huntington’s disease management clinics","authors":"D. Duffin, S. Sarangi","doi":"10.1558/CAM.36402","DOIUrl":"https://doi.org/10.1558/CAM.36402","url":null,"abstract":"Shared decision making (SDM) as a corrective to paternalism - particularly in relation to treatment options - is a much-discussed theme in healthcare research and practice. The communicative/interactional dimensions of SDM have lately received scholarly attention, albeit limited to a few clinic sites. The Huntington's disease (HD) management clinic, which is the site of this study, involves the co-presence of family members in their carer role, since the patient with HD may lack the cognitive ability to participate adequately in the decision-making process. We closely examine 12 audio-recorded clinic consultation transcripts, using the combined framework of theme-orientated discourse analysis and activity analysis. Our analytical focus is on how decisions are formulated and shared, or not shared, by the co-participants (the consultant, the patient and the carers) and the extent to which the consultant and the carers negotiate their 'expert' assessments of the patient's current and future management scenarios. We first outline a step-wise structure of decision making - to include problem designation, problem confirmation, generation of options and their assessment, and formulation and confirmation of decision. Contrary to how SDM is represented in various models in the literature, these different steps are interactionally dispersed and become negotiable in particular clinic sessions. Our findingssuggest that the consultant routinely uses three main strategies to steer the decision-making process: foregrounding the decision itself, foregrounding the temporal dimension and foregrounding the person/ carer dimension. Moreover, carer participation differs depending on the carer's relationship with the patient and other contingent matters. -","PeriodicalId":39728,"journal":{"name":"Communication and Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85853613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Concepts of health, ethics, and communication in shared decision making. 共同决策中的健康、伦理和沟通概念。

Communication and Medicine Pub Date : 2017-01-01 DOI: 10.1558/cam.32845

Lauris Christopher Kaldjian

{"title":"Concepts of health, ethics, and communication in shared decision making.","authors":"Lauris Christopher Kaldjian","doi":"10.1558/cam.32845","DOIUrl":"https://doi.org/10.1558/cam.32845","url":null,"abstract":"Shared decision making depends on respectful dialogue that allows patients and clinicians to discuss medical facts and the beliefs and values that give them meaning for a particular patient. This dialogue is most likely to succeed when tests and treatments are placed within a purpose-oriented landscape that sets goals of care in the foreground so that the direction of decision making is clear before too much focus is placed on interventional options. The beliefs and values that guide patients allow them to identify and prioritize their most important goals of care in light of other dimensions of decision making. These beliefs and values will also reveal concepts of health that anchor goals of care. When patients and clinicians disagree about treatments or goals, it may be because a clinician is guided by a biostatistical concept of health, while a patient is guided by one that prioritizes well-being. Such disagreements may also be described in terms of patient preference (autonomy) and the clinician's assessment of the patient's best interests (beneficence). By probing the beliefs and values that explain goals of care and concepts of health, dialogue can help reconcile disagreements in shared decision making. And even when resolution is not forthcoming, and a decision must be 'un-shared', dialogue can demonstrate respect for patients through the consideration clinicians show when they take time to understand and explain.","PeriodicalId":39728,"journal":{"name":"Communication and Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36270925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 27

Developing a new empathy-specific admissions test for applicants to medical schools: A discourse-pragmatic approach. 为医学院申请者开发一种新的移情入学测试:话语实用主义方法。

Communication and Medicine Pub Date : 2017-01-01 DOI: 10.1558/cam.31522

Gabrina Pounds, Charlotte Salter, Mary Jane Platt, Pauline Bryant

{"title":"Developing a new empathy-specific admissions test for applicants to medical schools: A discourse-pragmatic approach.","authors":"Gabrina Pounds, Charlotte Salter, Mary Jane Platt, Pauline Bryant","doi":"10.1558/cam.31522","DOIUrl":"https://doi.org/10.1558/cam.31522","url":null,"abstract":"The ability to empathise with patients is an important professional skill for doctors. Medical students practise this skill as part of their medical education, and are tested on their use of empathy within their final examination. Evidence shows that appropriate training makes a difference but that natural aptitude also plays a role. Most medical schools, therefore, probe applicants' basic understanding of empathy at admissions interviews. The purpose of the project presented in this paper was to apply existing understanding of how empathy may be communicated in a clinical context (building on a literature review by Pounds [2011]) to develop a new empathy-specific medical admissions interview station, probing applicants' empathic communicative performance (not just theoretical knowledge) and fitting the widely used Multiple Mini Interview (MMI) format. The paper outlines how this tool was developed, trialled and implemented by: (1) conceptualising empathic communication in discourse-pragmatic terms - that is, as a set of specific but context-dependant empathic speech acts; and (2) formulating and trialling a written and two oral versions of a situational test, capable of probing the applicants' ability to communicate empathically in everyday conversation and suitable for use at Norwich Medical School and other similar educational institutions.","PeriodicalId":39728,"journal":{"name":"Communication and Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36271302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Quantitative metaphor usage patterns in Chinese psychotherapy talk. 汉语心理治疗谈话中的数量隐喻使用模式。

Communication and Medicine Pub Date : 2017-01-01 DOI: 10.1558/cam.27688

Dennis Tay

引用次数: 8