Wium Anna, Gerber Berna
Centre for Medical Ethics and Law, University of Stellenbosch.
S Afr J Commun Disord. 2016 Dec 1;63(1):e1-e15. doi: 10.4102/sajcd.v63i1.174.
A significant number of medications that are prescribed by doctors to treat cancers, tuberculosis and infections are ototoxic. Disclosure of ototoxic risks is ethical practice as patients have the right to be properly informed about and involved in decisions about their health care. Often, doctors fail to disclose such information.
This research investigated whether a group of doctors working in a South African academic hospital inform their patients about the ototoxic risks associated with specific medications, and if not, explore the reasons for it. It was determined what the participants' knowledge levels of ototoxicity were as knowledge is seen as a precursor to disclosing information to their patients. A further aim of the research was to determine whether audiologists should expand their role by sharing information with patients and other professionals in the management of ototoxicity and in the hospital.
There were 90 participants included in the study through convenience sampling, which represented interns, medical officers, registrars and consultants in the neonatal intensive care unit, intensive care unit, ear-nose-throat, and internal and family medicine departments. The research made use of a descriptive survey design that collected mainly quantitative data and a limited amount of qualitative data through questionnaires. The data were descriptively analysed, and the qualitative data were listed and quantified.
The research firstly determined the participants' knowledge and understanding of ototoxicity, and it was found that there was room for improvement. With reference to the current practices of doctors in the prescription of ototoxic medicines, it was found that disclosure of ototoxic risks was limited, mostly because of a lack of time and insufficient knowledge. In comparing knowledge and practices between levels of employment, it was found that particular post levels performed better than others. The participants regarded the role of the audiologist as team member important, although very few referred their patients for audiological monitoring when they prescribe ototoxic medication.
A need for additional support to doctors was identified, which indicates that audiologists should expand their role to include the provision of continued professional development activities and to renew their efforts to advocate their role in the hospital so that doctors are made aware of the importance to refer their patients for ototoxic screening and monitoring.
医生开的用于治疗癌症、结核病和感染的大量药物具有耳毒性。披露耳毒性风险是符合道德规范的做法,因为患者有权充分了解并参与有关其医疗保健的决策。然而,医生常常未能披露此类信息。
本研究调查了在南非一家学术医院工作的一组医生是否会告知患者特定药物相关的耳毒性风险,若未告知,则探究其原因。鉴于知识被视为向患者披露信息的前提,研究还确定了参与者对耳毒性的知识水平。该研究的另一个目的是确定听力学家是否应通过与患者及医院其他专业人员分享耳毒性管理方面的信息来扩大其作用。
通过便利抽样,该研究纳入了90名参与者,他们分别来自新生儿重症监护病房、重症监护病房、耳鼻喉科、内科和家庭医学科的实习生、医务人员、住院医师和顾问。该研究采用描述性调查设计,主要通过问卷收集定量数据和少量定性数据。对数据进行描述性分析,定性数据进行列表和量化。
该研究首先确定了参与者对耳毒性的知识和理解,发现仍有改进空间。关于医生目前开具耳毒性药物的做法,发现耳毒性风险的披露有限,主要原因是时间不足和知识欠缺。在比较不同职业水平之间的知识和做法时,发现特定职位水平的表现优于其他职位。参与者认为听力学家作为团队成员的作用很重要,尽管很少有人在开具耳毒性药物时将患者转介进行听力监测。
确定了医生需要额外支持,这表明听力学家应扩大其作用,包括提供持续专业发展活动,并继续努力在医院宣传其作用,以使医生意识到将患者转介进行耳毒性筛查和监测的重要性。