Decision-making dilemmas of paediatricians: a qualitative study in Japan
Decision-making dilemmas of paediatricians: a qualitative study in Japan
复制标题
DOI：
10.1136/bmjopen-2018-026579
复制
发表时间：
2019-08-01
期刊：
影响因子：
2.9
通讯作者：
Ohga, Shouichi
中科院分区：
文献类型：
--
作者：
Sasazuki, Momoko;Sakai, Yasunari;Ohga, Shouichi
目的描述儿科医生在治疗危及生命的儿童时应用的关键决策过程以及参与此类护理的儿科医生的心理社会经验。设计我们对2014年至2015年的每位参与者进行了半结构化的个人面对面访谈。每次访谈的内容都经过全面的定性分析。参与者是经过委员会认证的儿科医生，在为患有严重疾病或残疾的儿童做出决定方面具有足够的经验。我们重复有目的的抽样和分析，直到我们达到饱和的类别data.Results我们进行了采访15儿科医生。他们每个人都报告了他们在做出关键决策时遇到的独特和重叠的困境类别。这些困境包括五种类型的因果因素：（1）儿科医生的信念;（2）追求病人的最佳利益;（3）寻求医疗适当的计划;（4）面对父母和家庭;（5）社会环境问题。困境是在这五个要素之间相互冲突的相互作用中发生和发展的。我们进一步将这五个要素分为三个主要领域：决策者（决策者）;家庭，同事和社会（过程）之间的共识，并相应的输出的决定（后果）。结论这是第一个定性研究，以展示儿科医生的决策过程的框架和复杂的结构，他们面临的困境。我们的数据表明，有必要建立和实施一个有效的支持系统，儿科医生，如结构化的专业教育和论据，创造社会共识，帮助他们达到最佳的计划，管理重病儿童。
Objective To delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care.Design We conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis.Participants Participants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data.Results We performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians' convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence).Conclusions This is the first qualitative study to demonstrate the framework of paediatricians' decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.