解决临床医生的道德困境:Covid-19期间混合方法评估的含义
Jennifer A Palmer1,2, Megan Mccullough3,4, Jolie Wormwood3,5
1Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America.
PloS one
|September 15, 2023
概括
在COVID-19期间,临床医生的道德困境很常见,影响了81%的退伍军人卫生管理局 (VA) 临床医生. 诸如患者访问限制和资源短缺等因素也有所贡献,突出显示了未来医疗保健危机干预措施的需求.
科学领域:
- 医疗保健伦理学 医疗保健伦理
- 临床心理学 临床心理学
- 公共卫生 公共卫生
背景情况:
- 临床医师的道德困扰是一个公认的问题,特别是在临终决策方面.
- 由于高死亡率和复杂的决策,COVID-19大流行加剧了道德困境.
- 了解退伍军人健康管理局 (VA) 内的道德困难对于临床医生和患者的福祉至关重要.
研究的目的:
- 为了检查在COVID-19大流行期间VA临床医生中临床医师道德困境的流行情况.
- 确定与道德困境相关的人口和职业因素.
- 探索导致道德困境的情况.
主要方法:
- 一项融合混合方法研究,使用20个VA医疗中心的VA临床医生在线调查.
- 在COVID-19高峰期收集关于人口统计,临床实践和道德困境强度的定量数据.
- 通过对促成情况的开放项目收集的定性数据,以主题分析.
主要成果:
- 在323名受访者中,81%的人在COVID-19的高峰期报告道德困境.
- 女性性别与增加道德困境的几率有关.
- 老年医疗/息护理和内部/家庭/初级护理与减少的道德痛苦有关.
- 关键因素包括患者访问限制,临床不确定性,资源短缺和个人风险.
结论:
- 在早期的COVID-19大流行期间,临床医生的道德困扰非常普遍.
- 道德上的痛苦源于个人,系统和情境因素.
- 确定的贡献者提供干预目标,以减轻未来危机和日常护理中的道德困境.
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