Health Technology Assessment, Epidemiology and Communication, CNR-IFC Italian National Research Council-Institute of Clinical Physiology, c/o Ecotekne University Campus, Prov.le Lecce-Monteroni, 73100, Lecce, Italy,
Insights Imaging. 2013 Oct;4(5):647-53. doi: 10.1007/s13244-013-0272-6. Epub 2013 Aug 1.
Inappropriate ionising medical imaging has been escalating in the last decades. This trend leads to potential damage to health and has been associated to bioethical and legal issues of patient autonomy.
While the doctrine underlines the importance of using informed consent to improve patient autonomy and physician-patient communication, some researchers have argued that it often falls short of this aim. There are basically two different informed consent practices. The first - the so-called "event-based model" - regards informed consent as a passive signature of a standard unreadable template, performed only once in each medical pathway. The second - the so-called "process-based model" - integrates information into the continuing dialogue between physician and patient, vital for diagnosis and treatment.
Current medical behaviour often embraces the event-based model, which is considered ineffective and contributes to inappropriateness. We sought, in this review, to analyse from juridical and communication standpoints whether process-based informed consent can deal with scientific uncertainties in radiological decision-making. The informed consent is still a distinctive process in defence of both patients' and physicians' health and dignity in rule-of-law states and consequently in curtailing the abuse of ionising medical radiation.
• Inappropriate ionising medical imaging is widespread and increasing worldwide. • This trend leads to noteworthy damage to health and is linked to the issue of patient autonomy. • Some authors have argued that informed consent often falls short of improving patient autonomy. • Process-based informed consent can deal with scientific uncertainties to contrast inappropriateness. • Informed consent is still a distinctive process in defence of both patients and physicians.
在过去几十年中，不适当的电离医疗成像呈上升趋势。这种趋势可能对健康造成损害，并与患者自主权的生物伦理和法律问题有关。
虽然该学说强调了使用知情同意来提高患者自主权和医患沟通的重要性，但一些研究人员认为，它往往未能达到这一目标。知情同意有两种基本的实践方式。第一种是所谓的“基于事件的模型”，它将知情同意视为对标准不可读模板的被动签名，仅在每条医疗路径中执行一次。第二种是所谓的“基于过程的模型”，它将信息整合到医生和患者之间的持续对话中，这对诊断和治疗至关重要。
目前的医疗行为通常采用基于事件的模型，该模型被认为是无效的，并导致了不适当的情况。在本次综述中，我们从法律和沟通的角度分析了基于过程的知情同意是否可以处理放射决策中的科学不确定性。在法治国家中，知情同意仍然是保护患者和医生健康和尊严的独特过程，从而可以遏制电离医疗辐射的滥用。
不适当的电离医疗成像在全球范围内广泛存在且呈上升趋势。
这种趋势会对健康造成明显的损害，并与患者自主权问题有关。
一些作者认为，知情同意往往未能提高患者自主权。
基于过程的知情同意可以处理科学不确定性，以对抗不适当的情况。
知情同意仍然是保护患者和医生的独特过程。
