Ekdahl Anne Wissendorff, Hellström Ingrid, Andersson Lars, Friedrichsen Maria
Department of Geriatric Medicine, Vrinnevi Hospital, Norrköping, Sweden.
BMJ Open. 2012 May 31;2(3). doi: 10.1136/bmjopen-2012-001063. Print 2012.
To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients.
A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire.
The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients.
Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: 'being challenged' by this patient group and 'being a small part of the healthcare production machine'. Both categories were explained by the core category 'lacking in time'. The reasons for the feeling of 'being challenged' were explained by the subcategories 'having a feeling of incompetence', 'having to take relatives into consideration' and 'having to take cognitive decline into account'. The reasons for the feeling of 'being a small part of the healthcare production machine' were explained by the subcategories 'at the mercy of routines' and 'inadequate remuneration system', both of which do not favour elderly patients with multimorbidity.
Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients.
探讨医生对于住院老年患者参与医疗决策的想法和考量。
一项定性研究，采用焦点小组访谈法对医生进行访谈，运用扎根理论进行解读，并辅以问卷调查。
研究背景为瑞典两个县的三家不同医院。对医疗科室中具有老年患者护理经验的医生（n = 30）进行了五个焦点小组访谈。
医生们表示，对于患有多种疾病的老年患者，他们无法提供良好的护理，包括让这些患者参与医疗决策，这让他们感到沮丧。发现了两个主要类别：受到这个患者群体的“挑战”以及“成为医疗保健生产机器的一小部分”。这两个类别都由核心类别“时间不足”来解释。“受到挑战”这种感觉的原因由子类别“感到能力不足”、“必须考虑亲属”和“必须考虑认知能力下降”来解释。“成为医疗保健生产机器的一小部分”这种感觉的原因由子类别“受制于常规”和“薪酬体系不完善”来解释，这两个子类别都不利于患有多种疾病的老年患者。
医生发现，患有多种疾病的老年患者会让他们产生职业能力不足的挫败感，因为他们无法优先照顾这个常见且数量迅速增长的患者群体，也无法让他们参与医疗决策。产生这种感觉的原因是缺乏时间、能力、整体观念、合适的常规流程以及针对这些患者的合理薪酬体系。
