患者からの脅威とその医療意思決定への影響:横断的,ランダム化試験
I S Kristiansen1, O H Førde, O Aasland
1Institute of Public Health, University of Southern Denmark, DK-5000 C, Odense, Denmark. isk@sam.sdu.dk
Lancet (London, England)
|June 22, 2001
まとめ
医者の苦情などのネガティブな経験は,臨床的決定を変化させなかった. しかし,患者や親戚からの直接的な脅威に直面すると,医師は戦略を変えた.
科学分野:
- 医療倫理 医療倫理について
- 臨床的意思決定に関する意思決定
- 医者の福祉 医者の福祉
背景:
- ノルウェーの医師にとって,ネガティブな経験は一般的です.
- これらの経験には,苦情,メディアへの曝露,財務上の請求,警察への通知などが含まれます.
- これらの反応の原因と効果を理解することは極めて重要です.
研究 の 目的:
- 患者や親戚から医師が直面するネガティブな反応の種類や原因を調査する.
- これらのネガティブな経験が,後の臨床的決定に与える影響を判断する.
- 脅威を含むシミュレーションされた臨床シナリオに対する医師の反応を評価する.
主な方法:
- ノルウェーの医師1260人のランダムなサンプルにアンケートが配布されました.
- 医師はまた,5つのケースシミュレーションを完了し,半分は脅威を含むシナリオを受信しました.
- 脅威の存在に基づく意思決定戦略を比較するためにデータを分析しました.
主要な成果:
- 回答した医師の47%が,ネガティブな体験を報告した.
- ネガティブな経験は,ケースシミュレーションにおける一般的な戦略選択に影響を与えなかった.
- 脅迫を受けた医師は,特定のケース (胸痛,頭痛) で防御的戦略を採用する可能性が高くなった.
結論:
- 後の臨床的意思決定は,以前のネガティブな経験によって著しく影響を受けません.
- 患者や親戚からの直接的な脅迫は,医師が患者の願いを叶えることを促す可能性があります.
- 脅威に対する医師の反応については,さらなる調査が必要である.
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