Patient-clinician interactions in shared diabetes/nephrology consultations - A qualitative observation study.

Autor: Christensen LS; Department of Internal Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark., Bauer EH; Internal Medicine Research Unit, University Hospital of Southern Denmark, University of Southern Denmark, Odense, Denmark.; Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark.; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark., Primdahl J; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.; Hospital Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark.; The Danish Center for Expertise in Rheumatology, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
Jazyk: angličtina
Zdroj: Scandinavian journal of caring sciences [Scand J Caring Sci] 2024 Dec; Vol. 38 (4), pp. 984-995. Date of Electronic Publication: 2024 Sep 03.
DOI: 10.1111/scs.13299
Abstrakt: Background: The incidence of chronic disease is increasing worldwide which, in turn, increases the demand for healthcare services. To meet these demands, healthcare systems are adapting their services in order to reduce treatment costs and ensure coherence for patients with multiple diseases. One form of adaptation is shared outpatient consultations between internal medical specialties. However, little is known about how patients interact with multiple clinicians in shared consultations.
Aim: This project aimed to explore how patients with diabetes and chronic kidney disease interact with multiple clinicians in a shared outpatient setting.
Research Methods: We performed a qualitative ethnographic study, combining focused participant observations with informal field interviews. We included 17 participants, nine males and eight females with a mean age of 67.3 in the project. The data analysis was guided by Braun and Clarke's reflexive thematic analysis and Arthur Kleinman's theory of illness and disease.
Results: We found one over-arching theme: 'A consultation which encompassed both illness and disease' and four subthemes: (1) 'The medical focal point' pertained to the focus on physiological measurements in dialogue between patients and clinicians. (2) 'The possibility of negotiations' illustrated how decisions about dialysis and pharmacological treatment were based on negotiations. (3) 'Speaking different languages' displayed how patients used alternative illness-based explanations whereas clinicians tended to use biomedical language. (4) 'Perceptions of everyday life' concerned what patients considered was best for them when managing their illness and everyday lives.
Conclusion: Patients present information on how they balance life with physiological and psychosocial challenges. When clinicians employ a biomedical perspective, opportunities to gain information on patients' illness behaviours or cues to negotiate are missed. Patients prioritise functioning on a daily level over following treatment regimes. These findings are tenuous and require verification in similar studies in similar settings.
Short Phrases: Shared Outpatient Clinic, Patient-clinician interactions.
(© 2024 The Author(s). Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)
Databáze: MEDLINE
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