Lin Mei-Ling, Chen Ching-Huey
1PhD, RN, Head Nurse, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, and Adjunct Assistant Professor, Department of Nursing, Central Taiwan University of Science and Technology, and Adjunct Assistant Professor, Department of Nursing, Central Taiwan University of Science and Technology & Department of Nursing, Hungkuang University 2PhD, RN, Professor, Department of Nursing, Chang Jung Christian University.
J Nurs Res. 2017 Dec;25(6):464-470. doi: 10.1097/JNR.0000000000000188.
Respect for the autonomy of patients is essential in life-threatening medical decisions such as surgery. Even if a patient has the competency to make decisions, many obstacles exist that may influence his or her willingness to participate in the surgical decision-making process.
The aim of this study was to explore the perceived difficulties in surgical decision making and related factors among elective surgical patients.
This was a cross-sectional correlational study. A convenience sampling method was used to recruit patients from a medical center in southern Taiwan. Patients who had received elective surgery, were older than 20 years old, and were competent to make medical decisions were invited to participate. A structured questionnaire was developed by the researchers to collect demographic data, decision patterns, and perceived difficulties in surgical decision making. Acceptable validity and reliability of the questionnaire were confirmed before data collection.
Over 80% of the participants made the surgical decision by themselves or in collaboration with their family or physician. Less than 15% expected to make the surgical decision by themselves. Illness-related suffering was the greatest difficulty that participants faced. The patients who tended toward passive decision making faced greater difficulties in the dimensions of "do not understand information," "physician's lack of concern," and "difficulty in freely communicating with the physician" than their active decision-making peers. Male participants reported having more difficulty in communicating with their physician than their female peers. Age, education, and marital status were not significantly associated with perceived difficulties in surgical decision making.
Family participation in the medical decision-making process is expected by most patients. Although less than 20% of the participants in this study were categorized as passive decision makers, this group reported more difficulties than the active decision-making group. Healthcare professionals should be more active in communicating with patients who are largely silent during the decision-making process to elicit their preferences and needs with regard to surgical decisions.
在诸如手术等危及生命的医疗决策中，尊重患者的自主权至关重要。即使患者有能力做出决策，仍存在许多可能影响其参与手术决策过程意愿的障碍。
本研究旨在探讨择期手术患者在手术决策中感知到的困难及相关因素。
这是一项横断面相关性研究。采用便利抽样法从台湾南部的一家医疗中心招募患者。邀请年龄在20岁以上、有能力做出医疗决策且接受过择期手术的患者参与。研究人员编制了一份结构化问卷，以收集人口统计学数据、决策模式以及手术决策中感知到的困难。在数据收集之前，确认了问卷的可接受效度和信度。
超过80%的参与者自行或与家人或医生共同做出手术决策。不到15%的参与者期望自行做出手术决策。与疾病相关的痛苦是参与者面临的最大困难。倾向于被动决策的患者在“不理解信息”“医生缺乏关注”以及“与医生自由沟通困难”等方面比积极决策的同龄人面临更大困难。男性参与者报告称与医生沟通比女性同龄人更困难。年龄、教育程度和婚姻状况与手术决策中感知到的困难无显著关联。
大多数患者期望家人参与医疗决策过程。尽管本研究中不到20%的参与者被归类为被动决策者，但该组报告的困难比积极决策组更多。医疗保健专业人员应更积极地与在决策过程中大多沉默的患者沟通，以了解他们在手术决策方面的偏好和需求。
