评估启动透析的共享决策:关于台湾患者拒绝长期透析的定性研究
Yi-Ting Kuo1, Chang-Chyi Jenq2,3, Uen Shuen Li4
1Department of medical education, Taichung Veterans General Hospital, Taichung, Taiwan.
Journal of evaluation in clinical practice
|September 19, 2023
概括
医生经常说服患者开始透析,即使患者拒绝. 了解患者的观点是改善透析启动共享决策的关键.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医学伦理 医学伦理
- 健康心理学 心理健康心理学
背景情况:
- 共享决策 (SDM) 对于替代疗法模式的选择至关重要.
- 启动透析的SDM过程,特别是当患者拒绝医生的建议时,需要进一步探索.
研究的目的:
- 在SDM框架内调查医生对拒绝长期透析的患者的反应.
- 了解医生和患者关于拒绝透析的决策过程.
主要方法:
- 进行了深入的半结构面试,对10名拒绝长期透析的末期病患者和9名科医生进行了深度半结构面试.
- 面试于2020年3月至5月期间在台湾长光纪念医院进行.
- 数据被录音,转录,翻译和主题分析.
主要成果:
- 医生经常积极说服患者接受透析,优先考虑医疗最佳利益和透析后的生活质量.
- 患者拒绝透析的决策过程是代的,并考虑了超出生物医学方面的因素.
- 医生和患者对拒绝治疗的看法存在重大分歧.
结论:
- 目前医生主导的透析启动SDM涉及积极的说服,医生观点往往占主导地位.
- 为了提高SDM,医生必须承认并理解患者拒绝的原因以及客观健康和主观福祉之间的平衡.
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