McKeown Robert E, Reininger Belinda M, Martin Maurice, Hoppmann Richard A
Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA.
Acad Med. 2002 May;77(5):438-45. doi: 10.1097/00001888-200205000-00020.
Patients' and physicians' views of their roles in decision making have implications for patient care and medical education. This study was designed to determine perspectives of residents and patients on the amount of control each should have in health care decisions.
Data were collected from a self-administered questionnaire of 45 first-year residents and a parallel structured interview with 92 patients from three resident clinics. Information Seeking (IS) and Decision Making (DM) scales from the Autonomy Preference Index were supplemented by five clinical scenarios focused on decisions concerning hypertension, depression, cholecystectomy, hysterectomy, and prostate cancer. Analysis of variance (ANOVA) and repeated-measures ANOVA were used to test for significant differences in scores.
Patients' and residents' mean scores on IS were practically equivalent, indicating strong desire for information sharing. For DM, patients indicated a desire for slightly less than equal control in decisions, while residents thought patients should have a more than equal role. Given the specific clinical scenarios, the picture varied. Patients wanted equal roles in the hypertension, depression, and prostate cancer scenarios, while residents wanted to have more control in these decisions. Conversely, patients wanted greater control in the hysterectomy and cholecystectomy scenarios, and residents wanted a less than equal role in these decisions. Patients thought consultants such as surgeons desired the same role as their physicians, but residents assumed consultants wanted more control.
Patients from a disadvantaged population indicated a strong desire for information and participation in making decisions about their care. Understanding the similarities and discrepancies in patients' and first-year residents' perspectives on shared decision making can have consequences for the patient-physician relationship and medical education.
患者和医生对他们在决策中角色的看法对患者护理和医学教育具有重要意义。本研究旨在确定住院医师和患者对各自在医疗决策中应拥有的控制权数量的看法。
通过对45名一年级住院医师进行自填式问卷调查，并对来自三个住院医师诊所的92名患者进行平行结构化访谈来收集数据。自主性偏好指数中的信息寻求（IS）和决策制定（DM）量表由五个临床情景补充，这些情景聚焦于高血压、抑郁症、胆囊切除术、子宫切除术和前列腺癌的决策。使用方差分析（ANOVA）和重复测量方差分析来检验分数的显著差异。
患者和住院医师在IS量表上的平均得分几乎相等，表明他们对信息共享有强烈的渴望。对于DM量表，患者表示在决策中希望拥有略少于平等的控制权，而住院医师则认为患者应拥有超过平等的角色。考虑到具体的临床情景，情况有所不同。在高血压、抑郁症和前列腺癌情景中，患者希望拥有平等的角色，而住院医师则希望在这些决策中拥有更多控制权。相反，在子宫切除术和胆囊切除术情景中，患者希望拥有更大的控制权，而住院医师则希望在这些决策中拥有少于平等的角色。患者认为外科医生等顾问希望与他们的医生拥有相同的角色，但住院医师则认为顾问希望拥有更多控制权。
来自弱势人群的患者表示强烈渴望获取信息并参与有关其护理的决策。了解患者和一年级住院医师在共同决策方面观点的异同可能会对医患关系和医学教育产生影响。
