期刊
PATIENT EDUCATION AND COUNSELING
卷 105, 期 3, 页码 524-533出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.pec.2021.08.017
关键词
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资金
- Mildred Blaxter postdoctoral fellowship from the Foundation for the Sociology of Health and Illness
- National Institute for Health Research School for Primary Care Research
- National Prevention Research Initiative
- Alzheimer's, Biotechnology and Biological Sciences Research Council
- British Heart Foundation
- Cancer Research UK
- Scottish Government Health Directorate
- Department of Health, Diabetes UK
- Economic and Social Research Council
- Engineering and Physical Sciences Research Council
- Health and Social Care Research Division
- Public Health Agency
- Northern Ireland
- MRC
- Stroke Association
- Wellcome Trust
- Welsh Government
- World Cancer Research Fund [MR/J000515/1]
- Oxford NIHR Biomedical Research Centre
- NIHR Oxford and Thames Valley Applied Research Collaboration
This study found that clinicians' responses to patient refusals of referrals are crucial in avoiding negative consequences in consultations. When clinicians acknowledged the legitimacy of patient refusals, negative consequences were avoided, and the conversation was briefer and smoother.
Objective: Guidelines recommend that clinicians should offer patients with obesity referrals to weight management services. However, clinicians and patients worry that such conversations will generate friction, and the risk of this is greatest when patients say no. We examined how doctors actually respond to patient refusals, and how patients reacted to clinicians in turn. Methods: Conversation analysis of 226 GP-patient interactions recorded during a clinical trial of weight management referrals in UK primary care. Results: Some clinicians responded to refusals by delivering further information or offering referral again. These actions treated patient refusals as unwelcome, and acted to pursue acceptance instead. However, pursuit did not lead to acceptance. Rather, pursuing acceptance lengthened consultations and led to frustration, offence, or anger. Clinicians who accepted refusals and closed the consultation avoided friction and negative emotional displays. Conclusion: Patient refusals have the potential to create negative consequences in the consultation and clinician responses were key in avoiding these. When clinicians acknowledged the legitimacy of patient refusals, negative consequences were avoided, and the conversation was briefer and smoother. Practice Implications: When patients refuse the offer of a free weight management referral, GPs should accept this refusal, rather than trying to persuade patients to accept. (c) 2021 Elsevier B.V. All rights reserved.
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