Warranting the decision-maker, not the decision: How healthcare practitioners evaluate the legitimacy of patients' unprompted requests for risk-reducing mastectomy.
Warranting the decision-maker, not the decision: How healthcare practitioners evaluate the legitimacy of patients' unprompted requests for risk-reducing mastectomy.
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保证决策者，而不是决定：医疗保健从业者如何评估患者自发要求的降低风险乳房切除术的合法性。
DOI：
10.1016/j.pec.2019.03.007
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发表时间：
2019
影响因子：
3.5
通讯作者：
Brown SL
中科院分区：
文献类型：
--
作者：
Brown SL
目的共享决策的存在是为了协调医疗从业者尊重患者自主权的责任，同时确保做出良好的决策。患者有时会主动要求进行带有医疗和其他风险的手术，例如降低风险的乳房切除术(RRM)。面对他们几乎没有参与的预先形成的决定，尚不清楚从业者如何在尊重自主权和确保做出良好决定之间进行协调。方法对英格兰西北部一家乳房单位的相关患者-从业者访谈进行了定性研究。我们调查了10名从业者如何处理19名患者自发提出的RRM请求。结果从业者同情患者对癌症风险的苦恼，认为RRM是合法的帮助，但对“情感上”的选择持谨慎态度。从业者并不寻求确定选择是否正确，而是通过让自己相信患者是“明智的”和“知情的”决策者来“保证”患者，因此他们的决定是可信的。从业者提供信息，并通过推迟决定和呈现描述RRM失败或伤害的“如果”情景来测试患者的决心。结论：情绪上和有决心的患者可以接受RRM，而没有证据表明做出了良好的决定。实践含义：论证理论提出了一种伦理上可靠的和临床上可行的方法，从业者通过这种方法引出、检查并在适当的情况下挑战支撑患者决策的论点。
ObjectiveShared decision-making exists to reconcile healthcare practitioners’ responsibilities to respect patients’ autonomy whilst ensuring well-made decisions. Patients sometimes make unprompted requests for procedures that carry medical and other risks, such as risk-reducing mastectomy (RRM). Faced with pre-formed decisions into which they have had little input, it is unclear how practitioners can reconcile respecting autonomy with ensuring well-made decisions.MethodsQualitative study of linked patient-practitioner interviews in a breast unit in North-West England. We examined how 10 practitioners addressed 19 patients’ unprompted requests for RRM.ResultsPractitioners empathised with patients’ distress about cancer risk, regarded RRM as legitimate to help, but were wary of choices made ‘emotionally’. Practitioners did not seek to establish whether choices were well-made but, instead, ‘warranted’ patients by satisfying themselves that patients were ‘sensible’ and ‘informed’ decision-makers, and thus their decisions could be trusted. Practitioners provided information, and tested patients’ resolve by delaying decisions and presenting ‘what if’ scenarios depicting failure or harm from RRM.ConclusionPatients who present emotionally and with resolution can receive RRM without evidence of a well-made decision.Practice Implications: Argumentation theory proposes an ethically robust and clinically practicable approach, whereby practitioners elicit, examine and, where appropriate, challenge arguments underpinning patients’ decisions.
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乳腺癌治疗决策中责任和所有权的伦理：与患者和外科医生观点协商的三角测量。
DOI：
--
发表时间：
2010
期刊：
Social Science & Medicine (1967)
影响因子：
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作者：
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Clayman, ML
DOI：
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2004
期刊：
影响因子：
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作者：
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Nancy La Pelle
影响因子：
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作者：
Cribb, Alan;Entwistle, Vikki A.
通讯作者：
Entwistle, Vikki A.
影响因子：
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作者：
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