Janssen N B A T, Oort F J, Fockens P, Willems D L, de Haes H C J M, Smets E M A
Academic Medical Centre/University of Amsterdam, PO Box 22660, 1100 DE Amsterdam.
J Med Ethics. 2009 May;35(5):276-82. doi: 10.1136/jme.2008.025031.
Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present.
To investigate patients' preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results.
Vignettes study.
Department of Gastroenterology, Academic Medical Centre, the Netherlands.
810 consecutive colonoscopy patients.
A home-sent questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed.
Wish to be informed and importance of information.
Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients' information preference was also related to age, mood and coping style.
Difficulty of vignettes.
Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested.
在医疗沟通中，讨论治疗风险变得越来越重要。尽管有相关规定，但医生仍必须决定提供多少以及何种信息。
调查患者对于结肠镜检查小并发症风险信息的偏好，以及医学和个人因素是否会影响这种偏好。根据研究结果提出一项信息披露政策。
vignettes 研究。
荷兰学术医疗中心胃肠病科。
810例连续接受结肠镜检查的患者。
通过邮寄包含三个 vignettes 的问卷进行调查。 vignettes 在结肠镜检查的适应症、并发症严重程度和风险水平方面存在差异。邀请患者表明他们希望被告知的意愿以及此类信息的重要性。此外，还评估了社会人口统计学、疾病相关和心理特征。
希望被告知的意愿和信息的重要性。
810份问卷中，68%被收回。无论结肠镜检查的适应症或并发症的严重程度如何，患者通常希望了解低风险并发症的信息。不过，风险水平确实有影响（OR = 2.48，SE = 0.28，p = 0.001）。如果是用于人群筛查或结肠癌诊断、并发症不太严重（出血）以及风险较小（0.01%和0.1%），则该信息被认为不太重要。患者的信息偏好还与年龄、情绪和应对方式有关。
vignettes 的难度。
患者通常希望了解所有可能的风险。然而，这可能会变得信息过载。建议采用逐步推进的方法。
Zotero 插件