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双相II型障碍治疗决策中医师观点与经验的质性探索

A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder.

作者信息

Fisher Alana, Manicavasagar Vijaya, Sharpe Louise, Laidsaar-Powell Rebekah, Juraskova Ilona

机构信息

School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.

Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, Camperdown, NSW, 2006, Australia.

出版信息

Community Ment Health J. 2017 Nov;53(8):958-971. doi: 10.1007/s10597-016-0077-4. Epub 2017 Jan 19.

Abstract

This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.

摘要

本研究定性探索了临床医生对双相II型障碍治疗决策的观点和经验。对20名有治疗成年双相II型障碍门诊患者经验的执业临床医生(n = 10名临床心理学家,n = 6名全科医生,n = 4名精神科医生)进行了半结构化访谈。访谈进行了录音,逐字转录,并使用框架方法进行了主题分析。还评估了专业经验以及患者参与决策的偏好。定性分析产生了四个相互关联的主题:(1)对诊断和治疗的(不)接受;(2)决策类型;(3)治疗的不确定性与权衡;(4)会诊中的决策。临床医生对治疗的偏好、专业经验以及自我报告的患者/家属参与偏好似乎会影响决策。本研究首次探索了临床医生对双相II型障碍治疗决策的观点和经验。研究结果表明了与临床医生相关的因素可能如何塑造治疗决策,并指出了潜在问题,如患者感觉参与度低于预期。

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