Lee Susan F, Kristjanson Linda J, Williams Anne M
School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia,
Support Care Cancer. 2009 Apr;17(4):445-50. doi: 10.1007/s00520-008-0516-z. Epub 2008 Nov 6.
Decision making in the context of palliative care is particularly complex given the unpredictable illness trajectories experienced by patients and the number of individuals who may be part of decision-making processes. This study aimed to describe the significant issues that influence the processes of care decision making, from the perspective of patients with advanced illness.
Patients (14), family members (7) and health professionals (18) were interviewed and field observations (100 h) of decision-making practices were undertaken in two Australian palliative care services. A systematic approach using grounded theory to collect and analyse the data was used to develop a theory of decision making from the patient's perspective.
The main issue experienced by palliative care patients was identified as a lack of involvement in decision making. One of the significant factors affecting the decision process is the type of relationship with health professionals that patients believe enhances their involvement in decision making. This was determined by the manner and focus of the health professional, their trustworthiness as well as the healthcare culture and environment. This paper provides a greater understanding of the perspective of patients in relation to their involvement in decisions related to palliative care.
鉴于患者经历的不可预测的疾病轨迹以及可能参与决策过程的人员数量，姑息治疗背景下的决策尤其复杂。本研究旨在从晚期疾病患者的角度描述影响护理决策过程的重要问题。
对14名患者、7名家庭成员和18名卫生专业人员进行了访谈，并在澳大利亚的两家姑息治疗服务机构对决策实践进行了100小时的实地观察。采用扎根理论的系统方法收集和分析数据，以从患者角度建立决策理论。
姑息治疗患者经历的主要问题被确定为缺乏参与决策。影响决策过程的一个重要因素是患者认为能增强其参与决策的与卫生专业人员的关系类型。这取决于卫生专业人员的方式和重点、他们的可信度以及医疗文化和环境。本文更深入地理解了患者在参与姑息治疗相关决策方面的观点。
