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外科医生在证据和行动之间出现不一致时,是否会经历道德矛盾? 一个调查和基于场景的研究
Bandele Okelana1, Amin Razi, David Ring
1Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Clinical orthopaedics and related research
|August 8, 2024
概括
当患者的痛苦,强烈的偏好或财务激励与自由裁量手术的最佳证据相冲突时,外科医生会经历道德矛盾. 解决这些因素可以提高肌肉骨手术中的工作满意度.
科学领域:
- 整形外科手术 整形外科手术
- 医学伦理 医学伦理
- 健康 专业 教育 卫生 专业 教育
背景情况:
- 道德不和,一种心理上的不适,源于道德价值观与行为之间的冲突.
- 在外科手术中,这可能源于感知到的危害与益处或外部压力,在没有明确证据的情况下进行手术.
- 了解道德矛盾是提高临床医生在实践中的快乐和福祉的关键.
研究的目的:
- 确定与压力相关的因素,在肌肉骨外科手术中反对最佳证据采取行动.
- 确定影响在任意情况下提供手术的可能性的因素.
主要方法:
- 基于场景的在线调查实验与114名肌肉骨外科医生进行.
- 参与者评价了与证据相反的行动压力和在12个场景中提供手术的可能性,随机选择患者和实践因素.
- 多级混合效应线性回归模型分析了关联,控制了混变量.
主要成果:
- 与最好的证据相反的行动压力更大与患者的绝望和强烈偏好有关.
- 独立于收入的外科医生收入和对外科手术没有经济利益减少了这种压力.
- 营销问题是增加提供手术的可能性的唯一因素.
结论:
- 患者因素 (压力,偏好) 和外科医生的财务激励与自由裁量骨折手术中的道德不和有显著的相关性.
- 外科医生,实践和协会需要积极的策略来缓解道德不和,并支持工作满意度.
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