改善知情同意:白血病患儿家长的建议
Improving informed consent: suggestions from parents of children with leukemia.
作者信息
Eder Michelle L, Yamokoski Amy D, Wittmann Peter W, Kodish Eric D
机构信息
Center for Health Research, Kaiser Permanente, Portland, Oregon, USA.
出版信息
Pediatrics. 2007 Apr;119(4):e849-59. doi: 10.1542/peds.2006-2208.
OBJECTIVE
The objective of this study was to report suggestions for improving the informed consent process from the perspective of parents of children with leukemia.
METHODS
Recommendations for improving informed consent were elicited from 140 parents of children who had been offered participation in a randomized clinical trial for the treatment of their acute leukemia. Four different methods and data collection time points were used with this group of parents, including open-ended, in-person interviews within 72 hours after the informed consent conference; follow-up telephone interviews 6 months after diagnosis; focus groups during year 3 of the project; and a parent advisory group on informed consent meeting in year 4.
RESULTS
The most frequently cited suggestions for improving informed consent during the interviews and focus groups related to giving parents more time to make their decision, the amount and type of information provided, organization of the consent conference, communication style, and providing additional materials. During the parent advisory group on informed consent meeting, parents developed specific guidelines for organization of the information that is presented during the consent process that include 7 major components: timing, sequence, checklist, checking for understanding, anticipatory guidance, segue into randomized clinical trial discussion with historical perspective, and choice.
CONCLUSIONS
Through the incorporation of parental perspectives that provide an authentic stakeholder voice, our research represents a true partnership approach to improving the consent process. Parents provided practical advice for improving informed consent that can be applied to most adult and pediatric patient populations.
目的
本研究的目的是从白血病患儿家长的角度报告改善知情同意过程的建议。
方法
从140名曾被邀请让其孩子参与治疗急性白血病的随机临床试验的患儿家长中征集改善知情同意的建议。对这组家长采用了四种不同的方法和数据收集时间点,包括在知情同意会议后72小时内进行的开放式面对面访谈;诊断后6个月的随访电话访谈;项目第3年的焦点小组讨论;以及第4年召开的关于知情同意的家长咨询小组会议。
结果
在访谈和焦点小组讨论中,最常被提及的改善知情同意的建议涉及给予家长更多时间做决定、所提供信息的数量和类型、同意会议的组织、沟通方式以及提供额外资料。在关于知情同意的家长咨询小组会议期间,家长们制定了在同意过程中呈现信息的具体组织指南,其中包括7个主要部分:时间安排、顺序、清单、检查理解情况、预期指导、结合历史视角引入随机临床试验讨论以及选择。
结论
通过纳入能提供真实利益相关者声音的家长观点,我们的研究代表了一种改善同意过程的真正合作方法。家长们提供了可应用于大多数成人和儿科患者群体的改善知情同意的实用建议。