ABSTRACT

The purpose of this study is to explore how older adults and physicians negotiate the plan of care during daily rounds in the hospital setting. We audio-recorded 40 physician–patient interactions during daily rounds in a small teaching hospital. We analyzed the data using conversation analysis, a qualitative method that examines the turns-of-talk during interactions. We focused the analysis on how physicians introduced the plan of care and how the plan of care was subsequently negotiated with the patient. Physicians often introduced the plan in two different ways that have a persuasive design: leading with evidence and medical expertise or, for sensitive topics in which the plan could be disagreeable, using preplan sequences to delicately introduce the plan of care and assess patient response. Patients negotiated the plan of care by displaying resistance, both passively and actively. Despite patients sharing their evidence for their preferred plan of care in resisting the physician’s plan, physicians often closed the negotiation by reorienting to a different aspect of the plan of care.

摘要

本研究的目的是探讨老年人和医生如何在医院环境中的日常查房中协商护理计划。我们在一家小型教学医院的日常查房中录制了 40 次医患互动。我们使用对话分析来分析数据，这是一种定性方法，可以检查交互过程中的谈话转折点。我们重点分析了医生如何介绍护理计划以及随后如何与患者协商护理计划。医生通常以两种具有说服力的不同方式介绍计划：以证据和医学专业知识为主导，或者对于计划可能不受欢迎的敏感话题，使用预先计划的顺序来巧妙地介绍护理计划并评估患者的反应。患者通过被动和主动地表现出抵抗来协商护理计划。尽管患者在抵制医生的计划时分享了他们偏爱的护理计划的证据，但医生通常会通过重新定位护理计划的不同方面来结束谈判。