Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2010 Jun;39(6):708-13. doi: 10.1016/j.ejvs.2010.02.012. Epub 2010 Mar 29.
To explore what kind of information surgeons communicate with patients diagnosed with an abdominal aortic aneurysm, and if the information provided regarding the disorder and treatment options available complies with legal requirements.
Dutch vascular surgeons sound-recorded consultations with their patients. Recordings were scored using a checklist based on ethical considerations and five statutory categories of information on: (1) the disorder, (2) procedure and aim of surgery, (3) consequences and risks of surgery, (4) watchful observation and (5) individual prognosis regarding state of health. Each category was represented by several information items, which were scored dichotomously ('not mentioned' or 'mentioned'). A category was considered sufficiently addressed if at least one of its items was mentioned.
Thirty-five consultations were recorded (13 patients with aneurysmal diameter <5.5 cm and 22 with diameter >or=5.5 cm). In a minority of recordings, all five categories were addressed: 1/13 (8%) and 9/22 (41%), respectively. None of the information items was discussed consistently in every recording. Although most patients were informed about the proposed treatment option (11/13; 85% and 19/22; 86%), the alternative treatment option was mentioned only occasionally (4/13; 31% and 14/22; 64%).
Patients with an abdominal aneurysm are informed inconsistently about their disorder and treatment options. Information is often less than that legally required. This may hinder shared decision making.
探讨外科医生与诊断为腹主动脉瘤的患者沟通的信息类型,以及所提供的关于疾病和可用治疗方案的信息是否符合法律要求。
荷兰血管外科医生对其患者的咨询进行录音。使用基于伦理考虑和五个法定信息类别的检查表对录音进行评分:(1)疾病,(2)手术程序和目的,(3)手术的后果和风险,(4)观察和(5)关于健康状况的个体预后。每个类别都由几个信息项目表示,这些项目以二分法(“未提及”或“提及”)进行评分。如果至少提到了其项目之一,则认为该类别得到了充分处理。
记录了 35 次咨询(13 名患者的动脉瘤直径<5.5cm,22 名患者的直径≥5.5cm)。在少数记录中,五个类别都有涉及:分别为 1/13(8%)和 9/22(41%)。没有一个信息项在每个记录中都被一致讨论。尽管大多数患者都被告知了拟议的治疗方案(11/13;85%和 19/22;86%),但偶尔才会提到替代治疗方案(4/13;31%和 14/22;64%)。
患有腹主动脉瘤的患者对其疾病和治疗方案的信息了解不一致。信息往往少于法律要求的信息。这可能会阻碍共同决策。