Pedersen R, Nortvedt P, Nordhaug M, Slettebø A, Grøthe K H, Kirkevold M, Brinchmann B S, Andersen B
Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway.
J Med Ethics. 2008 Apr;34(4):230-5. doi: 10.1136/jme.2006.018531.
A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians' consideration in daily clinical prioritisation in healthcare services for the aged is scarce.
To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.
A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.
20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.
Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients' needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.
The interviews in this study indicate that considerations of justice and patients' perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients.
为老年患者公平分配医疗服务是一项重大挑战，但探索临床医生在日常临床工作中对老年医疗服务进行优先级排序时的考量因素的定性研究却很匮乏。
探讨在老年患者医疗服务的临床优先级排序中，哪些标准、价值观及其他相关考量因素至关重要。
采用半结构化访谈指南，对45名从事老年患者医疗工作的临床医生进行访谈。运用诠释性内容分析法和模板组织风格对访谈进行定性分析。
挪威不同地区公立医院和养老院的20名医生和25名护士。
重要困境涉及社区护理供应不足和综合方法，以及某些专科服务的过度使用。一般未报告明显的年龄歧视，但由于一些更微妙的过程，老年医疗服务似乎存在不足，例如，主导性的考量因素、理念以及运营条件未充分关注老年患者的需求和公平性考量。临床优先级排序被描述为主要是将传统生物医学方法应用于运营条件。许多临床医生表示，在改善临终决策以及减少过度使用延长生命的治疗和住院方面存在潜力。
本研究中的访谈表明，在老年患者医疗服务中，应更加关注公平性考量和患者视角，以便在专科医疗方法与更普遍和综合的方法之间取得平衡。
