Patient-centered informed consent in surgical practice
Patient-centered informed consent in surgical practice
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DOI：
10.1001/archsurg.141.1.86
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发表时间：
2006-01-01
影响因子：
--
通讯作者：
Peterson, LM
中科院分区：
文献类型：
--
作者：
Bernat, JL;Peterson, LM
目的：审查手术及其并发症知情同意原则的医学、伦理和法律基础，特别是对于需要代理决策者的无行为能力患者；讨论同意原则的弹性，手术同意是否包括手术并发症的同意，并强调在患者与外科医生关系中沟通和共同决策的重要性；并讨论患者和代理人拒绝治疗、代理人决策的标准、有效沟通的障碍、医院伦理委员会在解决治疗争议中的作用，以及如何在以患者为中心的医学背景下重新概念化手术同意。 数据来源：我们回顾了 PubMed 对手术知情同意、患者与医生沟通、共同决策、以患者为中心的医学以及专业协会（特别是美国医学会）发布的同意指南的引用。外科医生和重症监护医学会。研究选择：我们选择了讨论或衡量手术治疗同意问题的文章。数据提取：我们提取了与手术实践中同意问题相关的数据。数据综合：我们研究了同意原则的定性方面。结论：手术同意不是一个事件或表格上的签名，而是一个持续的沟通过程，贯穿于术前、围手术期和术后护理。在以患者为中心的医学背景下，同意最好被概念化为与患者或其代理人共同决策。
Objectives: To review the medical, ethical, and legal basis of the doctrine of informed consent for surgery and its complications, particularly for an incapacitated patient who requires a surrogate decision maker; to discuss the elasticity of the consent doctrine, whether surgical consent encompasses consent for surgical complications, and emphasize the importance of communication and shared decision making in the context of the patient-surgeon relationship; and to discuss patient and surrogate refusal of treatment, standards of surrogate decision making, barriers to effective communication, the role of the hospital ethics committee in resolving disputes over treatment, and how to reconceptualize surgical consent in the context of patient-centered medicine.Data Sources: We reviewed PubMed citations for informed consent in surgery, patient-physician communication, shared decision making, patient-centered medicine, and consent guidelines published by specialty societies, particularly the American College of Surgeons and the Society for Critical Care Medicine.Study Selection: We selected articles in which issues of consent for surgical treatment were discussed or measured.Data Extraction: We extracted data relevant to questions of consent in surgical practice.Data Synthesis: We studied qualitative aspects of the consent doctrine.Conclusions: Surgical consent is not an event or a signature on a form but is an ongoing process of communication that continues throughout preoperative, perioperative, and postoperative care. In the context of patient-centered medicine, consent is best conceptualized as shared decision making with patients or their surrogates.