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Patients and doctors in dialogue about chronic illness
A small group of patients with chronic illnesses and primary care doctors participated in a structured, facilitated dialogue about chronic illness. Using a dialogue model adapted from the Public Conversations Project (Becker, Chasin, Chasin, Herzig and Roth, 1995; Herzig, 1998) that emphasizes experience-based knowledge and the sharing of experiences across differences, participating patients and doctors learned about the influence of chronic illness in each other's lives and work. Particular emphasis was placed on areas where improvement is needed in doctor-patient relationships. The study design was based on a participatory action research approach. It employed pre-dialogue interviews to develop a dialogue focus that would address participants' concerns and orient potential participants to the attitudes and values of talking across differences. The interviews also served as a screening tool to assess the ability and willingness of potential participants to engage in a cooperative dialogue process. Through follow-up interviews and questionnaires the participants reported outcomes and assessed the utility of the dialogue as a clinical method. Narrative analysis of the data emphasized the spoken and written words of participants and provided a means to bring their voices into the ongoing national conversation about healthcare. Most topics discussed in the dialogue focused on doctor-patient relationships, including what patient participants find helpful in their relationships with their doctors and what is missing that they wish was available to them. Major issues raised through the dialogue included: differences in what patients need and doctors can provide in chronic as compared to acute illnesses, ways diagnosis functions in doctor-patient relationships in chronic illness, the occurrence of "depression" in chronic illness and effects of witnessing illness. Participants were also interested in aspects of chronic illness that appear to be common across various diseases. Some patients noted the caring of the doctor participants and contrasted it with how they understand experiences with their own doctors. Over a two-hour dialogue, the participants moved the tone from one of interest and curiosity to one of deeply felt connection that facilitated learning and generated hope. Implications for patients, doctors and chronic illness care were addressed.
Lockerman, Georgene R, "Patients and doctors in dialogue about chronic illness" (2006). Doctoral Dissertations Available from Proquest. AAI3216955.