Tom Baker Cancer Centre, University of Calgary, Calgary, AB.
Clinical Research Unit, University of Calgary, Calgary, AB.
Curr Oncol. 2019 Dec;26(6):e742-e747. doi: 10.3747/co.26.5433. Epub 2019 Dec 1.
Of hospitalized patients in Canada, 7.5% experience an adverse event (ae). Physicians whose patients experience aes often become second victims of the incident. The present study is the first to evaluate how physicians in Canada cope with aes occurring in their patients.
Survey participants included oncologists, surgeons, and trainees at the Foothills Medical Centre, Calgary, AB. The surveys were administered through REDCap (Research Electronic Data Capture, version 9.0: REDCap Consortium, Vanderbilt University, Nashville, TN, U.S.A.). The Brief cope (Coping Orientation to Problems Experienced) Inventory, the ies-r (Impact of Event Scale-Revised), the Causal Dimension Scale, and the Institutional Punitive Response scale were used to evaluate coping strategies, prevalence of post-traumatic stress, and institutional culture with respect to aes.
Of 51 responses used for the analysis, 30 (58.8%) came from surgeons and 21 (41.2%) came from medical specialists. On the ies-r, 54.9% of respondents scored 24 or higher, which has been correlated with clinically concerning post-traumatic stress. Individuals with a score of 24 or higher were more likely to report self-blame ( = 0.00026) and venting ( = 0.042). Physicians who perceive institutional support to be poor reported significant post-traumatic stress ( = 0.023). On multivariable logistic regression modelling, self-blame was associated with an ies-r score of 24 or higher ( = 0.0031). No significant differences in ies-r scores of 24 or higher were observed between surgeons and non-surgeons ( = 0.15).The implications of aes for physicians, patients, and the health care system are enormous. More than 50% of our respondents showed emotional pathology related to an ae. Higher levels of self-blame, venting, and perception of inadequate institutional support were factors predicting increased post-traumatic stress after a patient ae.
Our study identifies a desperate need to establish effective institutional supports to help health care professionals recognize and deal with the emotional toll resulting from aes.
在加拿大住院的患者中，有 7.5%会经历不良事件 (AE)。经历 AE 的患者的医生往往会成为事件的第二受害者。本研究首次评估了加拿大的医生如何应对其患者发生的 AE。
调查参与者包括卡尔加里山麓医疗中心的肿瘤学家、外科医生和受训者。调查通过 REDCap（Research Electronic Data Capture，版本 9.0：REDCap 联盟，田纳西州纳什维尔，美国）进行。使用Brief cope（应对经验问题的取向）量表、IES-R（修订后的事件影响量表）、因果维度量表和机构惩罚反应量表来评估应对策略、创伤后应激的发生率以及与 AE 相关的机构文化。
在用于分析的 51 份回复中，30 份（58.8%）来自外科医生，21 份（41.2%）来自医学专家。在 IES-R 上，54.9%的受访者得分在 24 分或以上，这与临床关注的创伤后应激有关。得分在 24 分或以上的个体更有可能自责（=0.00026）和发泄（=0.042）。认为机构支持不佳的医生报告称存在明显的创伤后应激（=0.023）。在多变量逻辑回归模型中，自责与 IES-R 得分在 24 分或以上相关（=0.0031）。外科医生和非外科医生的 IES-R 得分在 24 分或以上无显著差异（=0.15）。AE 对医生、患者和医疗保健系统的影响是巨大的。我们超过 50%的受访者表现出与 AE 相关的情绪病理。更高水平的自责、发泄和对机构支持不足的感知是预测患者 AE 后创伤后应激增加的因素。
我们的研究表明，迫切需要建立有效的机构支持，以帮助医疗保健专业人员认识和应对 AE 带来的情绪影响。
