Rethinking Doctor-Patient Relationships

重新思考医患关系

• 批准号: 6761940
• 负责人: Michael Joel Yedidia
• 金额: $ 19.76万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-08-01 至 2006-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6761940
• 关键词: alternative medicine; behavioral /social science research tag; chronic disease /disorder; clinical research; curriculum; education evaluation /planning; extended care; health care model; health care quality; health services research tag; human subject; interview; medical education; model design /development; patient care; patient care personnel relations; self help

DESCRIPTION: (Provided by the Applicant) Transformation of provider-patient relationships will be essential to the success of efforts to achieve patient-centered care, as envisioned in the IOM report, Crossing the Quality Chasm. This research will investigate new ways of structuring doctor-patient relationships by studying five innovative practices: 1 ) cancer self-help and advocacy, 2) palliative care, 3) complementary medicine, 4) group visits for chronic illness care, and 5) new communications curricula in medical education. Three research questions will be addressed through study of each of these cases: 1. How can doctor-patient relationships be restructured within the following dimensions to promote patient-centered care: exercise of authority, distribution of responsibility among patients and providers, patient access to expertise, the range of patient needs addressed, affective involvement of both parties, possibilities for authenticity, and maintenance of trust? 2. What are the critical elements that promote or impede application of these innovations in medical practice? How can relationships be reformulated to optimally address specific health problems or serve distinctive patient populations? 3. How do the new possibilities for structuring relationships posed by these cases accord with dominant theoretical perspectives on doctor-patient relationships? How might existing models be revised to more effectively guide future research? A qualitative research approach serves the overall goal of developing new models in unexplored territory. In-depth interviews will be conducted with participants in each case and inductively analyzed to: a) study the dynamics of caring focusing on those features central to effectiveness; b) compare these features across cases and in relation to prevailing models of doctor-patient relationships; c) assess conditions under which each innovation functions, its acceptability to population subgroups, and the potential to expand its application more broadly; and d) generate hypotheses about promising changes in mainstream relationships and approaches for achieving them. The study is designed, first, to illuminate new possibilities for structuring doctor-patient relationships consonant with IOM's agenda for redesign of health care processes. Second, findings will inform initiatives in medical education as a vehicle for preparing doctors to assume new roles. Third, development of new conceptual frameworks and models will guide future research on the impact of doctor-patient relationships on quality of care.

描述：（由申请人提供）医疗服务提供者与患者关系的转变对于成功实现以患者为中心的护理至关重要，正如 IOM 报告《跨越质量鸿沟》中所设想的那样。这项研究将通过研究五种创新实践来探讨构建医患关系的新方法：1）癌症自助和宣传，2）姑息治疗，3）补充医学，4）慢性病护理的团体就诊，以及5）新的治疗方法。医学教育中的传播课程。通过对每个案例的研究将解决三个研究问题： 1. 如何在以下方面重构医患关系，以促进以患者为中心的护理：权力的行使、患者和提供者之间的责任分配、患者获得专业知识、满足患者需求的范围、双方的情感参与、真实性的可能性以及信任的维持？ 2. 促进或阻碍这些创新在医疗实践中应用的关键因素是什么？如何重新构建关系以最佳地解决特定的健康问题或服务于独特的患者群体？ 3. 这些案例所带来的构建关系的新可能性如何与医患关系的主流理论观点相一致？如何修改现有模型以更有效地指导未来的研究？ 定性研究方法服务于在未探索的领域开发新模型的总体目标。 我们将对每个案例的参与者进行深入访谈，并进行归纳分析，以： a) 研究关怀的动态，重点关注那些对有效性至关重要的特征； b) 比较不同病例的这些特征以及与流行的医患关系模式的关系； c) 评估每项创新发挥作用的条件、其对人口亚群体的可接受性以及更广泛地扩展其应用的潜力； d) 提出有关主流关系中有望发生变化的假设以及实现这些变化的方法。该研究的目的首先是为了阐明根据 IOM 重新设计医疗保健流程的议程构建医患关系的新可能性。其次，研究结果将为医学教育举措提供信息，作为帮助医生承担新角色的工具。第三，新概念框架和模型的发展将指导未来关于医患关系对护理质量影响的研究。