Cole Joanne, Kiriaev Oleg, Malpas Phillipa, Cheung Gary
Specialist Psychiatrist, Pennine Care NHS Foundation Trust, Stockport, UK.
Specialist Geriatrician, Mental Health Services for Older People, Auckland District Health Board, Auckland, New Zealand.
Australas Psychiatry. 2017 Dec;25(6):549-553. doi: 10.1177/1039856217734741. Epub 2017 Oct 9.
The objective of this study was to explore whether older people want their doctors to make treatment decisions on their behalf when they no longer have capacity to do so, and their reasons for these preferences.
A convenience sample of older people from two retirement villages were interviewed and asked to respond to a hypothetical vignette. Their responses were analysed using qualitative thematic methodology.
Thirty-seven people (56.8% female; mean age = 83.9 years; mean Mini Mental State Examination = 26.5) participated; 73.0% indicated that they would want their doctor to make treatment decisions on their behalf. Three key themes emerged: 1) trust in the doctor-patient relationship; 2) doctor-derived factors: knowledge and expertise, professionalism, role and responsibility; 3) patient-derived factors: vulnerability, dependence and reliance, compromised autonomy.
Our findings suggest that the paternalistic model within medical care can be an expectation of some older patients and if taking a paternalistic approach we should not underestimate the trust and power that is imparted to us.
本研究的目的是探讨老年人在失去决策能力时是否希望医生代表他们做出治疗决策，以及他们产生这些偏好的原因。
对来自两个退休村的老年人进行便利抽样访谈，并要求他们对一个假设的情景做出回应。使用定性主题方法对他们的回答进行分析。
37人（女性占56.8%；平均年龄 = 83.9岁；平均简易精神状态检查表得分 = 26.5）参与了研究；73.0%的人表示他们希望医生代表他们做出治疗决策。出现了三个关键主题：1）对医患关系的信任；2）医生方面的因素：知识与专业技能、专业性、角色与责任；3）患者方面的因素：脆弱性、依赖性与依靠性、自主性受损。
我们的研究结果表明，医疗保健中的家长式模式可能是一些老年患者的期望，如果采取家长式方法，我们不应低估赋予我们的信任和权力。
