患者在决策过程中的参与度是否随时间发生了变化？
Has patients' involvement in the decision-making process changed over time?
作者信息
van den Brink-Muinen Atie, van Dulmen Sandra M, de Haes Hanneke C J M, Visser Adriaan Ph, Schellevis François G, Bensing Jozien M
机构信息
NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
出版信息
Health Expect. 2006 Dec;9(4):333-42. doi: 10.1111/j.1369-7625.2006.00413.x.
OBJECTIVE
To get insight into the changes over time of patients' involvement in the decision-making process, and into the factors contributing to patients' involvement and general practitioners' (GPs) communication related to the Medical Treatment Act (MTA) issues: information about treatment, other available treatments and side-effects; informed decision making; asking consent for treatment.
BACKGROUND
Societal developments have changed the doctor-patient relationship recently. Informed decision making has become a central topic. Patients' informed consent was legalized by the MTA (1995).
DESIGN
Data of two cross-sectional studies, the First (1987) and Second (2001) Dutch National Survey of General Practice, were compared.
SETTING AND PARTICIPANTS
General practice consultations; 16 GPs and 442 patients in 1987; 142 GPs and 2784 patients in 2001.
METHODS
Consultations were videotaped and rated using Roter's Interaction Analysis System and observer questionnaires; pre- and post-consultation patient questionnaires; and GP questionnaires. Descriptive analyses and multivariate, multilevel analysis were applied.
MAIN RESULTS
Most patients reported to have received the information they had considered as important prior to the consultation. There were discrepancies in involvement in treatment decisions and in giving information about other available treatments, side-effects and risks. GPs who were more affective and gave more information, more often involved their patients, especially younger patients, in decision making. In 2001, more informed decision making was observed and the GPs asked consent for a treatment more often, but they less often asked for the patients' understanding.
CONCLUSION
Patients' involvement in decision making has increased over time, but not in every respect. However, this does not apply for all patients, especially the older ones. It should be questioned whether they are willing or capable to be involved and if so, how they could be encouraged.
目的
深入了解患者参与决策过程随时间的变化，以及促成患者参与和全科医生（GP）与《医疗治疗法》（MTA）相关问题沟通的因素：治疗信息、其他可用治疗方法和副作用；知情决策；请求治疗同意。
背景
社会发展最近改变了医患关系。知情决策已成为核心话题。患者的知情同意通过《医疗治疗法》（1995年）合法化。
设计
比较了两项横断面研究的数据，即第一次（1987年）和第二次（2001年）荷兰全国全科医疗调查。
设置和参与者
全科医疗咨询；1987年有16名全科医生和442名患者；2001年有142名全科医生和2784名患者。
方法
对咨询过程进行录像，并使用罗特互动分析系统和观察者问卷进行评分；咨询前和咨询后的患者问卷；以及全科医生问卷。应用描述性分析和多变量、多层次分析。
主要结果
大多数患者报告在咨询前已收到他们认为重要的信息。在参与治疗决策以及提供其他可用治疗方法、副作用和风险信息方面存在差异。更有情感且提供更多信息的全科医生更常让患者，尤其是年轻患者参与决策。2001年，观察到更多的知情决策，全科医生更频繁地请求治疗同意，但他们较少询问患者的理解情况。
结论
随着时间的推移，患者参与决策有所增加，但并非在各个方面。然而，这并非适用于所有患者，尤其是老年患者。他们是否愿意或有能力参与以及如果愿意应如何鼓励他们参与，这值得质疑。
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