Applying a deliberation model to the analysis of consultations in haemophilia: Implications for doctor-patient communication |
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| Affiliation: | 1. Department of Health Sciences, University of Milan, Milan, Italy;2. Department of Linguistic Sciences and Foreign Literatures, Catholic University of Milan, Milan, Italy;3. Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Fondazione IRCCS Ca'' Granda, Policlinico Hospital, Milan, Italy;4. Centro di Riferimento Regionale per le Emocoagulopatie, Policlinico Università Federico II, Naples, Italy;1. Institut Jules Bordet, Brussels, Belgium;2. Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l’Éducation, Brussels, Belgium;3. Centre de Psycho-Oncologie, Brussels, Belgium;4. Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium;1. Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;2. Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC;3. Center for Inherited Blood Disorders, Orange, CA;4. Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, Los Angeles, CA;5. Anschutz Medical Campus, University of Colorado Denver, Aurora, CO;6. Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA;1. Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK;2. Oxford University Clinical Research Unit, Hanoi, Vietnam;3. Radboud UMC, Nijmegen, Netherlands;4. Medical Services Administration, Ministry of Health, Hanoi, Vietnam;5. Hanoi Medical University, Hanoi, Vietnam;6. National Hospital of Tropical Diseases, Hanoi, Vietnam;7. Bach Mai Hospital, Hanoi, Vietnam;8. Hanoi University of Pharmacy, Hanoi, Vietnam;9. Health Strategy and Policy Institute, Hanoi, Vietnam;10. Brighton and Sussex University Hospital Trust, Brighton, UK;11. Barts Health NHS Trust, London, UK;12. UCL Partners, London, UK;13. Royal College of Physicians, London, UK;1. University of Antwerp, Belgium;2. RCSI |
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| Abstract: | ObjectiveLiterature highlights the importance of communication in order to achieve patient’s adherence. However, the specific dialogical components likely to favor patient adherence are not clear. In this study, the deliberation dialogue model was applied as an ideal model of optimal deliberation to real physician-patient consultations in the field of hemophilia in order to identify misalignments with the model and possible improvements in physician-patient communication.MethodsBy applying the deliberation model, we analyzed a corpus of 30 check-up consultations in hemophilia.ResultsOf 30 consultations, 24 (80%) contained 43 deliberation dialogues. Twenty-two (51%) deliberation dialogues were complete (e.g., included an opening stage with a clear statement of the problem, an argumentation stage in which both physician and patient participated, and a closing stage with an explicit patient commitment), whereas 21 (49%) deliberations were incomplete. These featured: Lack of/partial argumentation stage; Lack of closing stage; Lack of/partial argumentation stage and lack of closing stage.ConclusionsThe deliberation model can be applied to empirical data and allows to identify causes for suboptimal realizations of deliberation.Practice implicationsOnce a problem is acknowledged, attention could be paid to engage hemophilic patients in the argumentation stages and elicit their explicit commitment. |
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| Keywords: | Chronic care Deliberation dialogue Shared decision making Communication Patient-Centeredness Behavior change Hemophilia |
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