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Ethical Dilemmas II01:30

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Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...
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小児科の臨床医が共同で意思決定を行う際の選択意識を高める方法

Holly Hoa Vo1, Jeffrey D Robinson2, Douglas J Opel3

  • 1Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 1900 Ninth Ave, M/S: JMB-6; Seattle, WA, USA 98101.

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まとめ

臨床医は,共有意思決定 (SDM) 中の医療選択について患者に知らせるために様々なアプローチを使用します. 選択意識の伝達方法を標準化することで,小児のケアにおけるSDMの実施を改善することができます.

キーワード:
意思決定小児科共有する

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科学分野:

  • 医療 コミュニケーション
  • 共同意思決定 (SDM)
  • 小児保健医療

背景:

  • 患者中心のケアには 共有意思決定 (SDM) が重要で 患者は医療選択に 巻き込まれるのです
  • SDMの成功には 治療選択肢の効果的なコミュニケーションが不可欠です
  • 臨床医が選択意識を 作り出す方法を理解することは SDMの実施を改善する鍵です

研究 の 目的:

  • 小児臨床医がSDM中に選択意識を生み出すために使用する方法を特徴づける.
  • 複数の治療法を患者に提示するための臨床医のコミュニケーション戦略を分析する.
  • 小児の臨床体験における選択意識の確立の仕方の違いを特定する.

主な方法:

  • ビデオ録画された小児の遭遇を含む横断的観察研究の二次分析.
  • 臨床医がSDMを実施したと報告した21の遭遇から34の共有決定に適用された会話分析です.
  • 米国内の1つの小児病院の6つの小児科の臨床医を含む.

主要な成果:

  • 選択意識を高めるための2つの主要なアプローチが特定されました. "単一オプションアプローチ"と"複数オプションアプローチ".
  • 単一オプションのアプローチは,最初に推奨されるオプションを1つ提示し,必要に応じて他のオプションを提示します.
  • 複数の選択肢のアプローチは,すべての選択肢を事前に明示的に提示し,SDMをより明確に促進します.

結論:

  • 小児の臨床医はSDMの間に選択の意識を確立する際の変動を示しています.
  • 複数の選択肢のアプローチは SDMを明確に促進する上でより効果的です.
  • 選択意識のコミュニケーションを標準化することで,SDMの実施と有効性を高めることができます.