Lee K Jane, Havens Peter L, Sato Thomas T, Hoffman George M, Leuthner Steven R
Departments of Pediatrics, bSurgery, and cAnesthesia, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Pediatrics. 2006 Aug;118(2):723-30. doi: 10.1542/peds.2005-2830.
Our purpose for this work was to explore clinician knowledge, attitudes, and practice regarding assent for medical treatment and to compare current practice with existing American Academy of Pediatrics guidelines.
One of the investigators administered a questionnaire to clinicians who perform procedures on children at an academic tertiary care pediatric hospital to assess knowledge of assent for medical treatment and familiarity with the American Academy of Pediatrics policy statement on assent and to measure clinician attitudes and approaches to consent/assent in pediatrics.
Of 35 clinicians enrolled, 23 (66%) had heard of the term "assent," and 9 (26%) of 35 were aware of the American Academy of Pediatrics policy statement on assent. Twenty five (74%) of 34 thought 1 of the main goals of assent was to educate the child. Only 12 (35%) of 34 included the element of seeking the child's agreement as a goal of assent. In practice, the element of explaining the proposed treatment was "always" included by 26 (74%) of 35. The element of seeking the child's agreement was "always" included by 9 (26%) of 35.
The clinicians in this study had limited explicit knowledge of the concept of assent for medical treatment and were largely unaware of the recommendations from the American Academy of Pediatrics. Their attitudes and practice reflected implicit acceptance of the importance of including children in discussions about their medical care and reluctance to give children decision-making authority. A model of medical decision-making for children that includes education but does not allow children to share decision-making authority may be more applicable to clinical practice than the current American Academy of Pediatrics-supported model of assent.
我们开展这项工作的目的是探索临床医生在医疗同意方面的知识、态度和做法，并将当前的做法与美国儿科学会的现有指南进行比较。
一名研究人员向一家学术性三级护理儿科医院中为儿童实施手术的临床医生发放问卷，以评估其对医疗同意的知识、对美国儿科学会关于同意的政策声明的熟悉程度，并衡量临床医生在儿科同意/医疗同意方面的态度和方法。
在登记的35名临床医生中，23名（66%）听说过“医疗同意”一词，35名中有9名（26%）知晓美国儿科学会关于医疗同意的政策声明。34名中的25名（74%）认为医疗同意的主要目标之一是对儿童进行教育。34名中只有12名（35%）将寻求儿童的同意作为医疗同意的目标之一。在实际操作中，35名中有26名（74%）“总是”包含解释拟议治疗的内容。35名中有9名（26%）“总是”包含寻求儿童同意的内容。
本研究中的临床医生对医疗同意概念的明确知识有限，且大多不了解美国儿科学会的建议。他们的态度和做法反映出在隐含层面上认可让儿童参与医疗护理讨论的重要性，但不愿给予儿童决策权。一种包含教育但不允许儿童分享决策权的儿童医疗决策模式可能比当前美国儿科学会支持的医疗同意模式更适用于临床实践。
