Boston College, Chestnut Hill, Massachusetts 02467, USA.
Qual Health Res. 2011 Jun;21(6):839-52. doi: 10.1177/1049732311402097. Epub 2011 Mar 14.
Informed consent to treatment (ICT), designed to honor patient autonomy, has been an important subject of inquiry in many disciplines. To foreground the dynamic and dilemmatic tendencies of ICT practice implied by previous inquiries, I advanced relational dialectics theory into the realm of physicians' experiences with ICT. On performing a dialectical analysis of transcripts from focus group discussions with radiologists, I found them experiencing four primary tensions: (a) between simple and complex ICT; (b) between radiologist and patient control; (c) between standardized and idiosyncratic practice (involving struggles between documentation and conversational process, and between vague and detailed language use); and (d) between withholding and disclosing alternatives. Moreover, I drew on concepts from relational dialectics theory to capture the various ways radiologists negotiate these dialectics. I conclude with practical applications for physician and patient training and interprofessional coordination.
知情同意治疗 (ICT)，旨在尊重患者自主权，已成为许多学科探究的重要课题。为了突出先前研究中所暗示的 ICT 实践的动态和困境趋势，我将关系辩证法理论引入到医生对 ICT 的体验领域。在对放射科医生焦点小组讨论的记录进行辩证分析时，我发现他们经历了四种主要的紧张关系：(a) ICT 的简单与复杂之间；(b) 放射科医生与患者控制之间；(c) 标准化与个体差异之间（涉及文件记录和对话过程之间的斗争，以及模糊和详细的语言使用之间的斗争）；以及 (d) 隐瞒和揭示替代方案之间。此外，我借鉴了关系辩证法理论的概念，以捕捉放射科医生协商这些辩证法的各种方式。最后，我提出了医生和患者培训以及跨专业协调的实际应用。
