Yek J L J, Lee A K Y, Tan J A D, Lin G Y, Thamotharampillai T, Abdullah H R
Department of Anaesthesiology, Singapore General Hospital, Singapore, 169608, Singapore.
Duke-NUS Medical School, Singapore, 169608, Singapore.
BMC Med Ethics. 2017 Feb 2;18(1):6. doi: 10.1186/s12910-017-0172-2.
A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent.
A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients' perception of material risks, by trained interviewers. Patients' demographics were obtained. Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05.
Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education (p < 0.007), being employed (p < 0.046) and younger age group (p < 0.003) are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea (64.8%), Drowsiness (62.4%) and Surgical Wound Pain (58.8%). Patients ranked Heart Attack (59.3%), Death (53.8%) and Stroke (52.7%) as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist (52.2%), instead of letting the doctor decide (37.1%) or deciding for themselves (10.7%). Discussion with the anaesthetist (61.3%) is the preferred medium of communication compared to reading a pamphlet (23.4%) or watching a video (15.4%).
Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship.
一项横断面研究，旨在确定新加坡人群在麻醉同意过程中会将哪些视为重大风险，并确定在医疗决策中预测患者偏好的人口统计学因素，以制定更以患者为中心的知情同意书。
对新加坡总医院术前评估诊所1个月内就诊的21岁及以上患者进行了一项调查。由经过培训的访谈员发放问卷，以评估患者对重大风险的认知。获取了患者的人口统计学信息。采用曼-惠特尼U检验和克鲁斯卡尔-沃利斯单向方差分析。p < 0.05为具有统计学意义。
414名患者符合条件，其中26名拒绝参与，24名因语言障碍被排除。招募了364名患者。教育水平较高（p < 0.007）、就业（p < 0.046）和年龄较小（p < 0.003）是希望更多参与医疗决策的患者所具有的因素。性别、婚姻状况、手术类型和既往手术史并未影响他们的参与程度。大多数患者知道的并发症有恶心（64.8%）、嗜睡（62.4%）和手术伤口疼痛（58.8%）。患者将心脏病发作（59.3%）、死亡（53.8%）和中风（52.7%）列为他们希望更详细了解的最重大风险。大多数患者希望与麻醉医生共同做出决定（52.2%），而不是让医生决定（37.1%）或自己决定（10.7%）。与阅读宣传册（23.4%）或观看视频（15.4%）相比，与麻醉医生讨论（61.3%）是首选的沟通方式。
年龄和教育水平会影响医疗决策。尽管处于数字时代，但大多数患者在术前麻醉咨询时仍更喜欢门诊咨询而不是视听多媒体。与常见并发症相比，当地人群似乎更重视罕见但严重的并发症。这表明在知情同意过程中提供的信息需要结合具体情况，以加强医患关系。
