医学边缘——定性研究补充、替代和非特异性疗法在处理治疗不确定情况中的作用。
On the edges of medicine - a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations.
机构信息
Technical University of Munich, TUM School of Medicine, Institute of General Practice, Orleansstrasse 47, 81667, Munich, Germany.
Ludwig-Maximilans-Universität Munich, Institute of Sociology, Konradstr. 6, 80801, Munich, Germany.
出版信息
BMC Fam Pract. 2019 Apr 23;20(1):55. doi: 10.1186/s12875-019-0945-4.
BACKGROUND
In routine practice, general practitioners (GPs) see many patients for whom treatment might not be necessary, or evidence-based treatments are not available, yet often a treatment is prescribed. We denote such situations as therapeutically indeterminate. We aimed to investigate 1) whether therapeutically indeterminate situations play a role in the accounts of GPs in their practical work; 2) the role of complementary and alternative medicine (CAM) modalities or non-specific therapies, and of other strategies used in handling therapeutically indeterminate situations; and 3) factors associated with preferences for specific strategies.
METHODS
We performed semi-structured, individual face-to-face interviews with 20 purposively sampled, experienced GPs from Bavaria, Germany. A grounded theory approach was used for data analysis.
RESULTS
Participants reported that therapeutically indeterminate situations recur often in their daily practice. Professionally legitimate strategies such as empathetic consultations without providing a treatment intervention did not seem to suffice for coping with all of these situations. CAM treatments were used frequently, but motives varied. While some participants were convinced that these treatments were active and effective, others were uncertain or had doubts and used them as a relational tool, as a non-specific treatment or as a beneficial placebo. Conventional drugs were also used in a non-specific manner or despite doubts regarding the risk-benefit ratio. The extent to which GPs felt responsible for offering solutions in therapeutically indeterminate situations seemed to influence their preference for specific strategies.
CONCLUSION
Our results demonstrate the important role of CAM and the somewhat smaller role of non-specific therapies for German general practitioners in dealing with therapeutically indeterminate situations. The concept of therapeutically indeterminate situations may be helpful in better understanding why many general practitioners treat patients in situations where treatment does not appear to be clearly indicated.
背景
在常规实践中，全科医生（GP）会为许多治疗可能并非必要或缺乏循证治疗的患者就诊，但通常仍会开出治疗方案。我们将这些情况称为治疗不确定。我们旨在调查 1）治疗不确定情况在 GP 实际工作中的叙述中是否起作用；2）补充和替代医学（CAM）疗法或非特异性疗法的作用，以及在处理治疗不确定情况中使用的其他策略；3）与特定策略偏好相关的因素。
方法
我们对来自德国巴伐利亚州的 20 名经验丰富的 GP 进行了半结构化、个体面对面访谈。采用扎根理论方法进行数据分析。
结果
参与者报告称，治疗不确定情况在他们的日常实践中经常发生。专业上合理的策略，如不提供治疗干预的共情咨询，似乎不足以应对所有这些情况。CAM 治疗经常使用，但动机各不相同。虽然一些参与者确信这些治疗是有效的，但其他人则不确定或持怀疑态度，并将其用作关系工具、非特异性治疗或有益的安慰剂。常规药物也以非特异性方式使用，或尽管对风险效益比存在疑虑。GP 在治疗不确定情况下感到有责任提供解决方案的程度似乎影响了他们对特定策略的偏好。
结论
我们的研究结果表明，CAM 在德国全科医生处理治疗不确定情况中的作用重要，而非特异性疗法的作用稍小。治疗不确定情况的概念可能有助于更好地理解为什么许多全科医生在治疗似乎没有明确指征的患者时会进行治疗。
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