Putman Michael S, Yoon John D, Rasinski Kenneth A, Curlin Farr A
Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2014 Feb;29(2):335-40. doi: 10.1007/s11606-013-2653-4. Epub 2013 Oct 11.
Because of the potential to unduly influence patients' decisions, some ethicists counsel physicians to be nondirective when negotiating morally controversial medical decisions.
To determine whether primary care providers (PCPs) are less likely to endorse directive counsel for morally controversial medical decisions than for typical ones and to identify predictors of endorsing directive counsel in such situations.
Surveys were mailed to two separate national samples of practicing primary care physicians. Survey 1 was conducted from 2009 to 2010 on 1,504 PCPs; Survey 2 was conducted from 2010 to 2011 on 1,058 PCPs.
Survey 1: After randomization, half of the PCPs were asked if physicians should encourage patients to make the decision that the physician believes is best (directive counsel) with respect to "typical" medical decisions and half were asked the same question with respect to "morally controversial" medical decisions. Survey 2: After reading a vignette in which a patient asked for palliative sedation to unconsciousness, PCPs were asked whether it would be appropriate for the patient's physician to encourage the patient to make the decision the physician believes is best.
Of 1,427 eligible physicians, 896 responded to Survey 1 (63 %). Physicians asked about morally controversial decisions were half as likely (35 % vs. 65 % for typical decisions, p < 0.001) to endorse directive counsel. Of 986 eligible physicians, 600 responded to Survey 2 (61 %). Two in five physicians (41 %) endorsed directive counsel after reading a vignette describing a patient requesting palliative sedation to unconsciousness; these physicians tended to be male and more religious.
PCPs are less likely to endorse directive counsel when negotiating morally controversial medical decisions. Male physicians and those who are more religious are more likely to endorse directive counsel in these situations.
由于可能过度影响患者的决策，一些伦理学家建议医生在商讨道德上有争议的医疗决策时不要给出指导性建议。
确定初级保健提供者（PCP）对于道德上有争议的医疗决策比对于典型医疗决策更不可能赞同指导性建议，并确定在此类情况下赞同指导性建议的预测因素。
向两个不同的全国执业初级保健医生样本邮寄了调查问卷。调查1于2009年至2010年对1504名PCP进行；调查2于2010年至2011年对1058名PCP进行。
调查1：随机分组后，一半的PCP被问及医生是否应鼓励患者做出医生认为最佳的决策（指导性建议），涉及“典型”医疗决策，另一半被问及同样问题，涉及“道德上有争议的”医疗决策。调查2：在阅读一个病例 vignette（其中一名患者要求进行姑息性镇静直至失去意识）后，PCP被问及患者的医生鼓励患者做出医生认为最佳的决策是否合适。
在1427名符合条件的医生中，896名回复了调查1（63%）。被问及道德上有争议决策的医生赞同指导性建议的可能性只有一半（典型决策为65%，道德上有争议决策为35%，p < 0.001）。在986名符合条件的医生中，600名回复了调查2（61%）。五分之二的医生（41%）在阅读描述一名患者要求进行姑息性镇静直至失去意识的病例 vignette后赞同指导性建议；这些医生往往是男性且更虔诚。
PCP在商讨道德上有争议的医疗决策时不太可能赞同指导性建议。男性医生和更虔诚的医生在这些情况下更有可能赞同指导性建议。
