What triggers requests for ethics consultations
What triggers requests for ethics consultations
复制标题
是什么触发了道德咨询请求
DOI：
10.1136/ewjm.175.1.24
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
M. Danis
中科院分区：
文献类型：
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作者：
G. Duval;Leah Sartorius;B. Clarridge;G. Gensler;M. Danis
目的 调查是什么触发了临床医生提出伦理咨询请求。设计横断面电话调查。背景和参与者 随机选择的美国各地从事内科、肿瘤学和重症监护的医生。主要测量社会人口特征、医学和道德培训以及实践特征；引发咨询请求的道德问题类型以及触发咨询请求的因素。结果 在 344 名做出回应的医生中，有 190 名 (55.2%) 报告要求进行伦理咨询。最常见的是与临终决策、患者自主权问题和冲突相关的道德困境。导致咨询请求的最常见触发因素是需要帮助解决冲突；需要帮助与困难的家人、患者或代理人互动；需要帮助做出决定或规划护理；和情绪触发因素。少数族裔、在人口不足 50 万的社区行医或在美国接受过培训的医生更有可能要求协商来解决冲突。结论 冲突和其他情绪化的担忧比其他基于认知的担忧更容易引发咨询请求。在咨询时，伦理学家需要做好调解冲突和处理有时困难的情绪情况的准备。数据表明，道德顾问可以通过更积极主动地进行咨询以避免冲突并教育临床医生培养调解技能，从而为临床医生提供良好的服务。
Objective To investigate what triggers clinicians' requests for ethics consultations. Design Cross-sectional telephone survey. Setting and participants Randomly selected physicians throughout the United States who practice in internal medicine, oncology, and critical care. Main measurements Sociodemographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests. Results Of 344 responding physicians, 190 (55.2%) reported requesting ethics consultations. Most commonly these were for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were wanting help resolving a conflict; wanting assistance with interactions with a difficult family, patient, or surrogate; wanting help with making a decision or planning care; and emotional triggers. Physicians who were ethnically in the minority, practiced in communities under 500,000 population, or who were trained in the United States were more likely to request consultations to resolve conflict. Conclusions Conflicts and other emotionally charged concerns more commonly trigger consultation requests than other cognitively based concerns. When consulting, ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills.