Nancy L. Schoenborn MD, MHS, Susan M. Hannum PhD, Sarah E. Gollust PhD, Rebekah H. Nagler PhD, Mara A. Schonberg MD, MPH, Craig E. Pollack MD, MHS, Cynthia M. Boyd MD, MPH, Qian-Li Xue PhD, Mary Catherine Beach MD
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引用次数: 0
摘要
背景:公共卫生运动经常使用说服技术来促进健康行为,但医生使用说服技术却存在争议。我们试图研究老年妇女的观点:我们对来自巴尔的摩大都会地区的 20 名居住在社区的老年妇女进行了半结构化访谈。我们询问参与者是否认为医生试图说服病人在道德上是适当的,并探讨了她们的理由。我们探究了常用的说服技巧和两个决策情境实例--停止乳房 X 光检查和多次跌倒后搬出自己的房子。我们使用定性主题分析法对记录誊本进行编码,并将结果归纳为主要的主题:我们发现,对于劝说的道德适当性(主题 1),人们看法不一;支持劝说者的动机是劝说对患者健康的潜在益处,而反对者则认为患者应该是最终的决策者。观点取决于说服技巧(主题 2),情感诉求引起的反应最为负面,而使用事实和患者故事则更受好评。观点也因决策环境而异(主题 3),危害的严重性和确定性越高,参与者对说服的接受度就越高。参与者建议采用其他沟通方式进行说服(主题 4),强调对患者的尊重:我们的研究结果表明,劝说技巧的类型和决策背景是围绕劝说使用的伦理辩论中的重要考虑因素。将劝说的使用限制在高风险决策中,使用事实和患者故事而非情感诉求可能更容易被接受。
Older women's perspectives on the ethics of persuasion in doctor-patient communication
Background
Public health campaigns have often used persuasive techniques to promote healthy behaviors but the use of persuasion by doctors is controversial. We sought to examine older women's perspectives.
Methods
We conducted semi-structured interviews with 20 community-dwelling older women from the Baltimore metropolitan area. We asked whether participants thought it was ethically appropriate for doctors to try to persuade patients and explored their rationales. We probed about commonly used persuasive techniques and two example decisional contexts—stopping mammograms and moving out of one's house after multiple falls. We used qualitative thematic analysis to code the transcripts and summarized results into major themes.
Results
We found mixed views on the ethical appropriateness of persuasion (theme 1); supporters of persuasion were motivated by the potential benefit to patients' health, whereas opponents thought patients should be the ultimate decision-makers. Perspectives depended on the persuasive technique (theme 2), where emotional appeals elicited the most negative reactions while use of facts and patient stories were viewed more positively. Perspectives also varied by the decisional context (theme 3), where higher severity and certainty of harm influenced participants to be more accepting of persuasion. Participants suggested alternative communication approaches to persuasion (theme 4) that emphasized respect for patients.
Conclusions
Our findings suggest that the type of persuasive technique and the decisional context are important considerations in the ethical debate around the use of persuasion. Limiting the use of persuasion to high-stakes decisions and using facts and patient stories rather than emotional appeals are likely more acceptable.
期刊介绍:
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.