在我们信任的风险中? 关于膝关节置换手术的决定
Giles Birchley1, Wendy Bertram2, Andrew J Moore1
1Bristol Medical School, University of Bristol, UK.
Social science & medicine (1982)
|July 19, 2024
概括
在全膝关节置换决定中,有效的风险沟通是具有挑战性的. 患者和外科医生优先考虑信任而不是详细的风险讨论,这可能导致由疾病而不是知情选择影响的决定.
科学领域:
- 医学伦理 医学伦理
- 卫生沟通健康沟通
- 整形外科手术 整形外科手术
背景情况:
- 在全膝关节置换 (TKR) 中,共享决策需要明确的风险沟通.
- 少数TKR病例具有严重的意外结果,使风险披露复杂化.
- 目前的政策强调患者在医疗决策中的责任和选择.
研究的目的:
- 分析外科医生和患者在TKR决策过程中如何沟通风险.
- 探索风险沟通,信任和患者自主权之间的相互作用.
- 在风险披露中发现政策规范和临床实践之间的差异.
主要方法:
- 音频录制和分析了62次外科医生与患者的TKR咨询.
- 观察各种风险沟通策略:列表,对话,避免,决策工具.
- 对沟通模式和患者/外科医生优先事项的定性评估.
主要成果:
- 风险讨论往往是简短的,减少,或推迟双方.
- 患者和外科医生优先建立信任关系,而不是详细披露风险.
- 临床现实 (疼痛,不动) 与政策规范的选择和责任相冲突.
- 决策有时看起来是疾病强迫的,而不是自我决定的.
结论:
- 观察到的沟通实践可能会抵制将患者与临床医生的互动视为单纯的交易的政策框架.
- 信任和关怀在决策中起着至关重要的作用,需要一种细微的政策方法.
- 风险沟通在建立信任方面的作用需要进一步强调,承认其实际紧张关系.
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