Davis M A, Hoffman J R, Hsu J
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Acad Emerg Med. 1999 Aug;6(8):781-5. doi: 10.1111/j.1553-2712.1999.tb01206.x.
To test the hypotheses that ED patients' desires for medical information and for autonomy in decision making are inversely related to increasing acuity of illness, increasing age, and lower level of formal education.
The authors conducted a prospective study of ED patients who presented for care during seven nonconsecutive 24-hour periods. Of 804 patients approached, 665 completed a questionnaire that was administered by a trained research assistant. Patients rated their desire for medical information, and for participation in medical decision making, on two 10-cm visual analog scales. Patient acuity level was determined in routine fashion by trained triage nurses, who were unaware of the nature of this study.
Desire for information was uniformly high, and did not vary statistically between triage groups (p = 0.41). The most acutely ill patients (level I) were more likely to be excluded by the research interviewer (p < 0.001). Of included level I patients, desire to participate was not decreased (p < 0.01). Higher level of formal education (p = 0.036) and younger age (p < 0.001) were associated with greater desire for autonomy in decision making.
Among ED patients able to participate, higher acuity of illness was not associated with a decreased desire for medical information. Many very acutely ill patients preferred autonomy in medical decision making. Older patients and those with less formal education expressed a lesser desire for decision-making autonomy.
检验以下假设，即急诊患者对医疗信息的需求以及决策自主权与疾病严重程度增加、年龄增长和正规教育水平较低呈负相关。
作者对在七个非连续的24小时期间前来就诊的急诊患者进行了一项前瞻性研究。在804名接触的患者中，665名完成了由一名经过培训的研究助理发放的问卷。患者在两个10厘米的视觉模拟量表上对他们对医疗信息的需求以及参与医疗决策的意愿进行评分。患者的病情严重程度由经过培训的分诊护士以常规方式确定，这些护士并不知晓本研究的性质。
对信息的需求普遍较高，在分诊组之间无统计学差异（p = 0.41）。病情最危急的患者（I级）更有可能被研究访谈者排除（p < 0.001）。在纳入的I级患者中，参与意愿并未降低（p < 0.01）。正规教育水平较高（p = 0.036）和年龄较小（p < 0.001）与更大的决策自主权需求相关。
在能够参与的急诊患者中，疾病严重程度增加与对医疗信息的需求降低无关。许多病情非常危急的患者更倾向于医疗决策自主权。老年患者和正规教育程度较低的患者对决策自主权的需求较低。
