What are we Telling Our Patients? A Survey of Risk Disclosure for Anaesthesia in Australia and New Zealand
What are we Telling Our Patients? A Survey of Risk Disclosure for Anaesthesia in Australia and New Zealand
复制标题
我们要告诉患者什么？
DOI：
10.1177/0310057x1003800520
复制
发表时间：
2010
影响因子：
1.5
通讯作者：
D. Story
中科院分区：
文献类型：
--
作者：
A. Braun;K. Leslie;A. Merry;D. Story
我们研究的目的是确定四种常见临床情况下披露的风险范围：膝关节镜检查、腰椎椎板切除术、腹腔镜阑尾切除术和剖腹手术，然后确定每种情况下披露五种常见风险的频率。我们在奥克兰市立医院、皇家墨尔本医院和奥斯汀医院对麻醉师进行了一项试点调查（应答率为59%）。然后向500名随机选择的澳大利亚和新西兰麻醉师学院研究员发送网络调查（回复率29%）。在初步调查中，披露了广泛的风险：膝关节镜手术5例（范围0 - 13），腰椎椎板切除术7例（0 - 16），阑尾切除术6例（0 - 13），剖腹手术9例（0 - 24）。在网络调查中，所有风险的披露率从"很少"到"总是"不等。受访者更有可能披露风险不频繁，如果他们是男性（比值比5.7，P = 0.002）或完全在私人执业（比值比4.1，P = 0.02）。年龄> 45岁与披露频率无关（优势比1.65，P = 0.23）。虽然低回复率限制了我们许多研究结果的有效性和普遍性，但我们可以自信地得出结论，澳大利亚和新西兰的风险披露差异很大。这种巨大的变化应该引起所有麻醉师的关注。需要更多的工作来了解这种变化的原因，并在麻醉师中就应该披露的风险达成更强的共识。
The aim of our study was to determine the range of risks disclosed in four commonly-encountered clinical scenarios: knee arthroscopy, lumbar laminectomy, laparoscopic appendicectomy and laparotomy, and then to determine how often five commonly-disclosed risks were disclosed for each scenario. We conducted a pilot survey of consultant anaesthetists in the Auckland City Hospital, the Royal Melbourne Hospital and the Austin Hospital (response rate 59%). A web survey was then sent to 500 randomly-selected Australian and New Zealand College of Anaesthetists Fellows (response rate 29%). In the pilot survey, a wide range of risks were disclosed: five (range 0 to 13) for knee arthroscopy, seven (0 to 16) for lumbar laminectomy, six (0 to 13) for appendicectomy and nine (0 to 24) for laparotomy. In the web survey, the disclosure rates for all risks varied widely from “rarely” to “always”. Respondents were more likely to disclose risks infrequently if they were male (odds ratio 5.7, P=0.002) or exclusively in private practice (odds ratio 4.1, P=0.02). Age >45 years was not associated with disclosure frequency (odds ratio 1.65, P=0.23). While the low response rate limits the validity and generalisability of many of our findings, we can nevertheless confidently conclude that risk disclosure varies widely in Australia and New Zealand. This large variation should be of concern to all anaesthetists. More work is needed to understand the reasons for this variation, and to develop a stronger consensus among anaesthetists about what risks should be disclosed.