通过患者和医生对诊断过程的看法,确定共享决策的机会:一般实践中错误诊断索赔的定性分析
Sofie Jacobse1,2, Hanneke Rijkels-Otters1, Manon Eikens-Jansen3
1Department of General Practice, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
The European journal of general practice
|June 2, 2025
概括
共享决策 (SDM) 可以通过解决不确定性和患者背景来改善诊断过程. 在SDM中培训临床医生对于更好的诊断决策和患者护理至关重要.
科学领域:
- 医学沟通 医学沟通
- 诊断医学 诊断医学 诊断医学
- 以患者为中心的护理
背景情况:
- 共享决策 (SDM) 是一种首选的沟通模式,但其在诊断中的使用尚未得到充分研究.
- 错误实践索赔揭示了诊断过程中的问题.
- 需要了解SDM在诊断中可以在哪里应用.
研究的目的:
- 在诊断过程中确定共享决策可能有益的临床情况.
- 分析不当行为索赔,找到SDM的机会.
主要方法:
- 对2012-2020年荷兰全科医生关于诊断错误的不当行为索赔的观察性研究.
- 确定的SDM选择标准用于诊断过程 (不确定性,多选项,平衡).
- 第一个阶段:对1477个索赔进行了分类;第二阶段:使用GP和患者数据的感应主题分析分析了90个索赔.
主要成果:
- 18%的索赔 (261/1477) 符合SDM标准,测试订单问题是最常见的 (59.4%).
- 常见的诊断包括骨折,恶性瘤和感染.
- 出现了六个诊断考虑因素,突出了全科医生和患者之间缺乏共享的理解.
结论:
- SDM可以增强诊断过程,特别是讨论选项,测试条件和后续行动.
- 建议为临床医生提供量身定制的SDM培训,以改善诊断决策.
- 通过SDM解决诊断不确定性和患者背景是关键.
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