与急诊医生进行认知面试,以了解处置决策 痴呆症患者 边界病例
Anita N Chary1,2, Annika R Bhananker1,2, Rebecca Franks1
1Baylor College of Medicine, Houston, TX, USA.
概括
紧急诊所 (ED) 的医生经常面临痴呆症患者的边缘病例. 虽然许多公司提供解雇或录取选项,但他们很少明确地沟通这种选择,错过了共同决策的机会.
科学领域:
- 老年医学 老年医学
- 紧急医疗 紧急医疗
- 卫生沟通健康沟通
背景情况:
- 痴呆症患者经常出现在急诊室 (ED),他们的病情可以接受门诊或住院治疗,称为"边境病例".
- 在这些复杂的情况下,ED医生在这些复杂情况下所采用的决策过程和沟通策略尚不清楚.
研究的目的:
- 研究急诊室医生如何处理和沟通边界病例痴呆症患者的处置决策.
- 探索共享决策原则在多大程度上适用于向患者和护理合作伙伴传达这些关键选择.
主要方法:
- 对21名在学术医院的急诊科医生进行了认知访谈.
- 医生们被介绍了涉及边界病例痴呆症患者的情景,并被要求口头表达他们关于处置的决策和沟通策略.
- 对于与患者/护理伙伴参与,沟通内容和措辞相关的主题,响应被演编码.
主要成果:
- 接受采访的三分之二的医生表示,他们将考虑将入院和出院作为边界病例的可行选择.
- 然而,显著的少数人明确地将入院与出院作为患者或他们的护理伙伴的选择.
- 医生的沟通往往缺乏明确的选择框架,这可能会限制共同的决策.
结论:
- 共享决策是管理临界病例的相关框架,涉及急诊室的痴呆症患者.
- 实施结构化沟通策略可以加强患者和护理伙伴参与处置决策.
- 需要进一步的研究来开发和评估在这种临床环境中促进共享决策的干预措施.
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