Biases in the evaluation of self-harm in patients with disability due to spinal cord injury
Biases in the evaluation of self-harm in patients with disability due to spinal cord injury
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DOI：
10.1038/s41394-020-0293-6
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发表时间：
2020-05-27
影响因子：
1.2
通讯作者：
Stein, Michael Ashley
中科院分区：
文献类型：
--
作者：
Budd, Maggi A.;Haque, Omar Sultan;Stein, Michael Ashley
自杀是一个全球性问题，准确评估自我伤害的风险至关重要。即使是有道德原则的临床医生在评估脊髓损伤（SCI）等身体残疾患者的自我伤害时也会表现出偏见。自我伤害的评估是医疗保健临床医生的一项义务，高估或低估风险可能会破坏患者对他们护理的信任，可能导致参与度降低，对生活兴趣的冷漠增加，以及对健康治疗选择的依从性降低。案例介绍向读者介绍了三种偏见，可以影响决策时，评估病人的自我伤害的风险残疾患者：（1）无效的偏见，（2）脆弱的友好偏见，（3）灾难偏见。这些先入为主的观念来自于家长式作风、投射、低期望、怜悯和盲目乐观。在本文中，我们解释了在一个常见的情况下，每一个偏见如何影响临床决策的诊断，治疗，预后和预防SCI患者。当读者在临床环境内外遇到SCI患者时，可以进行个人反思和潜在的自我应用。讨论对残疾人和SCI患者的不加控制的偏见会破坏伦理道德。偏见是思维习惯，深思熟虑的临床和教育干预可以改善临床实践。与其他少数群体的医疗保健偏见的文献是有益的调查与残疾患者的偏见，特别是康复医学以外的临床医生。
Introduction Suicide is a global problem and accurate assessment of risk for self-harm is critical. Even morally principled clinicians can manifest bias when assessing self-harm in patients with physical disabilities such as spinal cord injury (SCI). Assessment of self-harm is an obligation for health care clinicians and overestimating or underestimating risk may undermine a patient's trust in their care, possibly leading to less engagement, increased apathy about having an interest in living, and less adherence to healthy treatment options. Case presentation Introduces readers to three biases that can impact decision-making regarding a patient with a disability when assessing the patient's risk for self-harm: (1) ineffectual bias, (2) fragile friendliness bias, and (3) catastrophe bias. These preconceptions are derived from a mix of paternalism, projection, low expectations, pity, and infantilization. In this paper, we explain how each bias can affect clinical decision-making regarding diagnosis, treatment, prognosis, and prevention for patients with SCI within a common case scenario. Readers can employ personal reflection and potential self-application when they encounter individuals with SCI in and outside clinical settings. Discussion Unchecked biases toward the disabled and patients with SCI can undermine ethical caregiving. Biases are habits of mind and thoughtful clinical and education interventions can improve clinical practice. The literature on health care bias with other minority groups is instructive for investigating biases related to patients with disabilities, and especially for clinicians outside of rehabilitation medicine.