Missed expectations? Physicians' views of patients' participation in medical decision-making
Missed expectations? Physicians' views of patients' participation in medical decision-making
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DOI：
10.1097/01.mlr.0000160415.08497.11
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发表时间：
2005-05-01
期刊：
影响因子：
3
通讯作者：
Whitney, SN
中科院分区：
文献类型：
--
作者：
McGuire, AL;McCullough, LB;Whitney, SN
目的：鼓励医生积极参与患者的临床决策，但这种期望还没有得到充分的检查，从医生的角度来看。我们的目的是确定和描述医生对患者参与决策的态度，并深入了解他们如何思考和构建决策过程。设计：这是一项关于医生报告的态度和实践的定性横断面研究。设置：该研究在私人执业和学术医生的实践中进行。参与者：共有53名来自初级保健和外科专业的学术和私人执业医生参加了这项研究。测量方法：我们对半结构化的个人访谈进行了定性分析。结果：在这项研究中的医生表达了一致的积极态度，病人参与医疗决策。他们将患者自主权确定为患者参与的基本理由，但往往超出了基于自主权的理由。一些人的动机是基本的慈善原则以及他们避免法律的责任的自身利益。许多医生认为他们的角色是教育患者的专家，但保留对决策过程的控制权，其他人则采取了更合作的方法，鼓励患者承担决策优先权。决策过程往往是修改病人，医生，和环境factors.Conclusions：在这项研究中的医生表现出积极的，灵活的方法，包括病人的决策。仅基于自主原则的共享决策的一维模型无法解释医生如何分配决策优先级的可变性，因此在伦理上是不充分的，
Objective: Physicians are encouraged to actively involve patients in clinical decision-making, but this expectation has not been adequately examined from the physicians' perspective. Our objective was to identify and characterize physicians' attitudes toward patient participation in decision-making and to gain insight into how they consequently think about and structure the decision-making process,Design: This was a qualitative cross-sectional study of physicians' reported attitudes and practices.Setting: The study took place in private practice and academic physicians' practices.Participants: A total of 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired, participated in the study.Measurements: We performed a qualitative analysis of semistructured individual interviews.Results: The physicians in this study expressed consistently positive attitudes toward patient participation in medical decision-making. They identified patient autonomy as an essential justification for patient participation but often went beyond an autonomy-based rationale. Several were motivated by the fundamental principle of beneficence as well as their own self-interest in avoiding legal liability. Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process, others took a more collaborative approach, encouraging patients to assume decisional priority. The decision-making process often was modified by patient, physician, and environmental factors.Conclusions: The physicians in this study demonstrated a positive, flexible approach toward including patients in decision-making. A one-dimensional model of shared decision-making based solely on the principle of autonomy fails to account for variability in how physicians allocate decisional priority and is therefore ethically inadequate,