在门诊实践中做出明智的决策:是时候回到基础
C H Braddock1, K A Edwards, N M Hasenberg
1Department of Medicine, VA Puget Sound Health Care System, Seattle 98108, USA. braddock@u.washington.edu
JAMA
|December 28, 1999
概括
在例行办公室访问中,医生与患者的共同决策往往是不完整的. 即使在简单的决策中,知情同意的关键要素也经常缺失,这凸显了改善沟通策略的必要性.
科学领域:
- 临床决策 临床决策
- 患者参与 患者参与
- 医学沟通 医学沟通
背景情况:
- 在临床实践中,越来越重视以患者为中心的护理和共享决策 (SDM).
- 对医生如何在日常办公室环境中实施SDM的理解有限.
- 需要评估患者参与例行临床接触的程度.
研究的目的:
- 评估知情决策过程的完整性和性质.
- 在初级保健医生和外科医生之间比较这些过程.
- 在例行办公室访问中分析决策.
主要方法:
- 一项横截面研究,涉及59名初级保健医生和65名外科医生的1057次录音办公室访问.
- 分析了3552个临床决策,使用适应决策复杂性 (基本,中级,复杂) 的标准.
- 评估重点是明智决策的要素,例如讨论干预措施和评估患者的理解.
主要成果:
- 只有9.0%的临床决定符合完全知情决策的标准.
- 根据复杂性而有所不同:基本决策为17.2%,中级决策为0%,复杂决策为0.5%.
- 对干预性质的讨论很常见 (71%),但对患者理解的评估很少 (1.5%).
结论:
- 在日常办公室实践中,对初级保健医生和外科医生的知情决策往往是不完整的.
- 即使调整了决策标准以考虑复杂性,缺陷仍然存在.
- 显然需要实施在临床实践中加强知情决策的策略.
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