Callaghan Katharine A, Fanning Joseph B
1 Vanderbilt University School of Medicine, The Center for Biomedical Ethics and Society, Nashville, TN, USA.
2 The Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Hosp Palliat Care. 2018 Feb;35(2):355-363. doi: 10.1177/1049909117707486. Epub 2017 May 10.
In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life.
To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions.
A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation.
SETTING/PARTICIPANTS: A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews.
The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician's assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present.
This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.
在临终关怀环境中，偏见可能会干扰患者对目标的表达，并阻碍以患者为中心的护理提供。尚无研究探讨临终时护理目标讨论中临床医生的偏见或偏见管理。
识别并确定临终护理目标讨论中姑息治疗临床医生的偏见及偏见管理策略的普遍性。
制定了一份具有相关领域的半结构化访谈指南以促进数据收集。直接要求参与者识别适用于该环境的偏见和偏见管理策略。两名研究人员根据扎根理论，通过一个迭代过程，使用25%的转录样本制定了一个编码本以识别主题。使用Cohen κ评估评分者间信度。结果为0.83，表明编码者之间几乎完全一致。数据达到饱和。
设置/参与者：对田纳西州中部的20名姑息治疗临床医生进行了目的抽样访谈。
接受访谈的20名临床医生识别出16种偏见和11种偏见管理策略。最常提到的偏见是反对积极治疗的偏见（n = 9），被描述为临床医生认为大多数临终干预并无益处。最常提到的偏见管理策略是自我识别偏见（n = 17），被描述为承认存在偏见。
这是第一项识别临终护理目标讨论中姑息治疗临床医生的偏见及偏见管理策略的研究。
