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与安乐死辩论相关的研究重点:我们仍需了解什么?改良德尔菲技术的结果

Research priorities relating to the debate on assisted dying: what do we still need to know? Results of a modified Delphi technique.

作者信息

Rodgers Mark, Booth Alison, Norman Gill, Sowden Amanda

机构信息

Centre for Reviews and Dissemination, University of York, York, UK.

York Trials Unit, University of York, York, UK.

出版信息

BMJ Open. 2016 Jun 7;6(6):e012213. doi: 10.1136/bmjopen-2016-012213.

Abstract

OBJECTIVE

To identify the main areas of uncertainty and subsequent research priorities to inform the ongoing debate around assisted dying.

DESIGN

Two-round electronic modified Delphi consultation with experts and interested bodies.

SETTING AND PARTICIPANTS

110 groups and individuals interested in the subject of end-of-life care and/or assisted dying were approached to participate. Respondents included health and social care professionals, researchers, campaigners, patients and carers predominantly based in the UK. In the first round, the respondents were asked to propose high-priority research questions related to the topic of assisted dying. The collected research questions were then deduplicated and presented to all respondents in a second round in which they could rate each question in terms of importance.

RESULTS

24% and 26% of participants responded to the first and second rounds, respectively. Respondents suggested 85 unique research questions in the first round. These were grouped by theme and rated in terms of importance in the second round. Emergent themes were as follows: palliative care/symptom control; patient characteristics, experiences and decisions; families and carers; society and the general public; arguments for and against assisted dying; international experiences/analysis of existing national data; suicide; mental health, psychological and psychosocial considerations; comorbidities; the role of clinicians; environment and external influences; broader topics incorporating assisted dying; and moral, ethical and legal issues. 10 of the 85 proposed questions were rated as being important (≥7/10) by at least 50% of respondents.

CONCLUSIONS

Research questions with the highest levels of consensus were predominantly concerned with understanding how and why people make end-of-life decisions, and which factors influence those decisions. Dissemination of these findings alongside a focused examination of the existing literature may be the most effective way to add evidence to the ongoing debate around assisted dying.

摘要

目的

确定主要的不确定性领域以及后续的研究重点,为围绕辅助死亡的持续辩论提供信息。

设计

与专家和相关机构进行两轮电子改良德尔菲咨询。

背景与参与者

邀请了110个对临终关怀和/或辅助死亡主题感兴趣的团体和个人参与。受访者主要包括英国的卫生和社会护理专业人员、研究人员、活动家、患者及护理人员。在第一轮中,要求受访者提出与辅助死亡主题相关的高优先级研究问题。然后对收集到的研究问题进行重复数据删除,并在第二轮中呈现给所有受访者,让他们根据重要性对每个问题进行评分。

结果

分别有24%和26%的参与者回复了第一轮和第二轮。受访者在第一轮中提出了85个独特的研究问题。这些问题按主题分组,并在第二轮中根据重要性进行评分。出现的主题如下:姑息治疗/症状控制;患者特征、经历和决策;家庭和护理人员;社会和公众;支持和反对辅助死亡的论据;国际经验/对现有国家数据的分析;自杀;心理健康、心理和社会心理因素;合并症;临床医生的作用;环境和外部影响;包含辅助死亡的更广泛主题;以及道德、伦理和法律问题。85个提出的问题中有10个被至少50%的受访者评为重要(≥7/10)。

结论

共识程度最高的研究问题主要涉及理解人们如何以及为何做出临终决策,以及哪些因素影响这些决策。传播这些研究结果并同时重点审查现有文献,可能是为围绕辅助死亡的持续辩论增加证据的最有效方式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/faf1/4908896/460fe09e53a5/bmjopen2016012213f01.jpg

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