Waterbury Hospital Emergency Department, Waterbury, CT; Yale University Department of Emergency Medicine, New Haven, CT.
Acad Emerg Med. 2014 Feb;21(2):122-9. doi: 10.1111/acem.12311.
This qualitative study aimed to characterize the barriers to informed discussions between patients and emergency physicians (EPs) about radiation risk from computed tomography (CT) and to identify future interventions to improve patient understanding of CT radiation risk.
This study used a focus group approach to collect concepts about radiation risk exposure from a national sample of EPs and a local sample of emergency department (ED) patients. A directed content analysis used an a priori medical ethics framework to explore themes from the focus groups while a subsequent normative ethics analysis compared these results with existing perceptions about discussing CT radiation risk.
Focus groups (three each for a total of 19 EPs and 27 patients) identified concepts consistent with core medical ethics principles: patients emphasized autonomy and nonmaleficence more than physicians, while physicians emphasized beneficence. Subjects' knowledge of radiation dose and risk were equivalent to previously published reports. When asked about whether they should talk about radiation with patients, 74% of EPs reported that radiation exposure should be discussed, but the study EPs self-reported doing so with only an average of 24% of patients. Patients reported wanting to hear about radiation from their physicians the next time they need CT scans and thought that a written handout would work better than any other method. When presented with options for how to discuss risk with patients, EPs reported needing easy access to risk information and preferred discussion over other communications approaches, but had mixed support of distributing patient handouts.
The normative view that radiation from diagnostic CT should be discussed in the ED is shared by patients and physicians, but is challenged by the lack of a structured method to communicate CT radiation risk to ED patients. Our analysis identifies promising interest among physicians and patients to use information guides and electronic order prompts as potential informational tools to overcome this barrier.
本定性研究旨在描述患者与急诊医师（EP）就计算机断层扫描（CT）辐射风险进行知情讨论的障碍，并确定未来可改善患者对 CT 辐射风险理解的干预措施。
本研究采用焦点小组方法，从全国 EP 样本和当地急诊部（ED）患者样本中收集有关辐射风险暴露的概念。定向内容分析使用预先确定的医学伦理框架来探索焦点小组的主题，随后的规范伦理分析将这些结果与关于讨论 CT 辐射风险的现有观念进行比较。
焦点小组（每组 3 次，共 19 名 EP 和 27 名患者）确定了与核心医学伦理原则一致的概念：患者比医生更强调自主权和不伤害原则，而医生则更强调善行。研究对象对辐射剂量和风险的了解与之前发表的报告相当。当被问及他们是否应该与患者讨论辐射问题时，74%的 EP 报告称应讨论辐射暴露问题，但研究中的 EP 仅平均与 24%的患者进行了讨论。患者报告说，下次需要 CT 扫描时希望从医生那里听到有关辐射的信息，并认为书面传单比任何其他方法都更有效。当提出与患者讨论风险的方法时，EP 报告说需要方便获取风险信息，并倾向于讨论而不是其他沟通方法，但对分发患者传单的支持不一。
患者和医生都认同在 ED 应讨论诊断性 CT 产生的辐射，但缺乏一种向 ED 患者传达 CT 辐射风险的结构化方法，这对这一观点构成了挑战。我们的分析确定了医生和患者都有使用信息指南和电子医嘱提示作为潜在信息工具来克服这一障碍的强烈兴趣。
