Integrative Medicine Unit, Rabin Medical Center and the Tel-Aviv University, Petah Tikva 49100, Israel.
Evid Based Complement Alternat Med. 2011;2011:170793. doi: 10.1093/ecam/nep032. Epub 2010 Oct 19.
The objective of this study was to examine complementary and alternative medicine (CAM) practitioners' (i) attitudes toward informed consent and (ii) to assess whether standards of practice exist with respect to informed consent, and what these standards look like. The design and setting of the study constituted face-to-face qualitative interviews with 28 non-MD, community-based providers representing 11 different CAM therapeutic modalities. It was found that there is great deal of variability with respect to the informed consent process in CAM across providers and modalities. No unique profession-based patterns were identified. The content analysis yielded five major categories related to (i) general attitude towards the informed consent process, (ii) type and amount of information exchange during that process, (iii) disclosure of risks, (iv) discussions of alternatives, and (v) potential benefits. There is a widespread lack of standards with respect to the practice of informed consent across a broad range of CAM modalities. Addressing this problem requires concerted and systematic educational, ethical and judicial remedial actions. Informed consent, which is often viewed as a pervasive obligation is medicine, must be reshaped to have therapeutic value. Acknowledging current conceptions and misconception surrounding the practice of informed consent may help to bring about this change. More translational research is needed to guide this process.
本研究旨在考察补充和替代医学(CAM)从业者(i)对知情同意的态度,以及(ii)评估在知情同意方面是否存在实践标准,以及这些标准的具体内容。研究的设计和环境包括对 28 名非医学博士、以社区为基础的提供者进行面对面的定性访谈,这些提供者代表了 11 种不同的 CAM 治疗模式。研究发现,CAM 领域的知情同意过程在提供者和模式之间存在很大的差异。没有发现独特的基于专业的模式。内容分析得出了五个与(i)对知情同意过程的总体态度、(ii)该过程中的信息交流类型和数量、(iii)风险披露、(iv)替代方案讨论和(v)潜在收益有关的主要类别。在广泛的 CAM 模式中,知情同意实践缺乏广泛的标准。解决这个问题需要协调一致和系统的教育、伦理和司法补救措施。知情同意在医学中通常被视为一种普遍的义务,必须进行重塑,以具有治疗价值。承认围绕知情同意实践的当前观念和误解可能有助于实现这一转变。需要更多的转化研究来指导这一过程。