Doctor's views on disclosing or withholding information on low risks of complication
Doctor's views on disclosing or withholding information on low risks of complication
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DOI：
10.1136/jme.2005.014936
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发表时间：
2007-02-01
影响因子：
4.1
通讯作者：
de Haes, J. C. J. M.
中科院分区：
文献类型：
--
作者：
Palmboom, G. G.;Willems, D. L.;de Haes, J. C. J. M.
背景：越来越多的量化信息正在成为可获得的并发症的风险，从医疗。在日常实践中，这就提出了一个问题，即是否每一种风险，无论多么低，都应该向患者披露。有什么好的理由可以这样做或不这样做？这将越来越成为一个两难的practitioners.Objective：报告医生的意见，是否披露或隐瞒低风险的并发症的信息。方法：在一个定性研究设计，37名受访者（胃肠病学家和妇科医生或产科医生）。对22名受访者进行焦点小组访谈，对15名受访者进行个人深入访谈。结果：医生对披露或隐瞒并发症风险信息存在疑虑，尤其是在1/200 ~ 1/10000的风险范围内。他们的考虑是否披露或隐瞒信息取决于一个复杂的混合病人和医生相关的原因;对医疗和个人的考虑;和对类型和目的的intervention.Discussion：即使风险的程度是重要的医生的考虑，可能的并发症的严重程度和病人的愿望和能力也有重要的作用。受访者表示，当有替代干预措施或患者可以预防或缓解风险时，应始终传达低风险。当披露风险的适当性受到怀疑时，医生应始终告诉患者，没有任何干预措施是没有风险的，让他们有机会收集他们需要或想要的所有信息，并使他们能够在早期发现并发症。
Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors' views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents ( gastroenterologists and gynaecologists or obstetricians) were included. Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor's considerations, the severity of the possible complications and patients' wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage.