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Originalarbeit

Behandler-Reaktionen auf die Meinungsäußerung von Patienten

Sequenzanalysen von Aufnahmegesprächen in der kardiologischen Rehabilitation

Published Online:August 26, 2016https://doi.org/10.1026/0943-8149/a000156

Abstract

Zusammenfassung. Die Interaktion zwischen Behandler und Patient kann die Behandlung und deren Ergebnis stark beeinflussen. Die Studie untersucht die Wirkung von aktivem Kommunikationsverhalten des Patienten im Aufnahmegespräch auf die unmittelbare kommunikative Reaktion des Behandlers. Es wurden 21 Audiomitschnitte von Aufnahmegesprächen zwischen N = 21 Patienten mit chronisch-ischämischer Herzkrankheit und N = 10 Behandlern an zwei kardiologischen Rehabilitationskliniken analysiert. Die Audiomitschnitte wurden mittels RIAS codiert und Sequenz- und Lag-Analysen durchgeführt. Hierbei wurde der Zusammenhang zwischen aktiven Patientenverhaltensweisen (Meinungsäußerung) und den darauf‏ ‎folgenden kommunikativen Reaktionen des Behandlers untersucht. Aktive Meinungsäußerungen durch Patienten sind insgesamt sehr selten. Unaufgeforderte Meinungsäußerungen, welche nicht durch eine Frage des Behandlers ausgelöst wurde, kamen noch seltener vor. Allerdings zeigte die Sequenzanalyse, dass Patientenverhaltensweisen mit dem Kommunikationsverhalten von Behandlern in Zusammenhang steht. Die Meinungsäußerung wird in vielen Fällen aber nicht als Grundlage für eine gemeinsame Entscheidungsfindung genutzt. Zukünftige Studien sollten klären, warum aktive Meinungsäußerungen nicht als Anlass für eine gemeinsame Entscheidungsfindung genutzt werden.


Physicians’ Reactions to Patients Expressing Their Opinion: Sequence Analysis of Admission Interviews in Cardiological Rehabilitation

Abstract. The communication between clinician and patient in the admission interview can have an impact on the subsequent treatment and outcome. This study focuses on the effect that a patient’s active communication has on the reaction of the clinician. In all, 21 audio recordings of the first consultations between N = 21 patients with IHD and N = 10 clinicians at two cardiac rehabilitation clinics were coded through RIAS. Sequence analysis and lag analysis were applied to the coded data, and the associations between the behavior of interest (patient’s opinion) and the reactions of the clinician were investigated. Patients actively voicing their opinion was rarely observed. The quantity of spontaneous expressions of the patient’s own opinion that were not triggered by a question from the clinician was even smaller. However, the sequence analysis shows that active patient behavior is associated with the communication behavior of the clinician. The active behaviors were not used as a basis for shared decision making. Future studies should clarify why patient expression of opinions does not lead to SDM.

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