Patient autonomy and the challenge of clinical uncertainty
Patient autonomy and the challenge of clinical uncertainty
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DOI：
10.1353/ken.2002.0018
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发表时间：
2002-09-01
影响因子：
1.4
通讯作者：
Danis, M
中科院分区：
文献类型：
--
作者：
Parascandola, M;Hawkins, J;Danis, M
生物伦理学家明确提出了医生和患者共同决策的理想，但在这样做的过程中，临床不确定性的作用还没有得到充分的正视。面对患者预后和最佳疗程的不确定性，许多医生回到了不披露和不讨论的模式，从而关闭了分享决策的机会。经验研究表明，在存在大量不确定性的情况下，医生发现更难坚持披露规范。他们可能担心承认自己的不确定性会破坏患者的信任，并给患者带来额外的困惑和焦虑。相反，我们认为，从长远来看，有效的信息披露将保护患者的信任，患者可以管理有关不确定性的信息。在存在大量不确定性的情况下，需要格外警惕，以确保向患者提供他们参与关于他们的护理的合作决策所需的工具和信息。
Bioethicists have articulated an ideal of shared decision making between physician and patient, but in doing so the role of clinical uncertainty has not been adequately confronted. In the face of uncertainty about the patient's prognosis and the best course of treatment, many physicians revert to a model of nondisclosure and nondiscussion, thus closing off opportunities for shared decision making. Empirical studies suggest that physicians find it more difficult to adhere to norms of disclosure in situations where there is substantial uncertainty. They may be concerned that acknowledging their own uncertainty will undermine patient trust and create additional confusion and anxiety for the patient. We argue, in contrast, that effective disclosure will protect patient trust in the long run and that patients can manage information about uncertainty. In situations where there is substantial uncertainty, extra vigilance is required to ensure that patients are given the tools and information they need to participate in cooperative decision making about their care.