Center for Biomedical Ethics and Society, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A.
Laryngoscope. 2020 Nov;130(11):2728-2735. doi: 10.1002/lary.28557. Epub 2020 Feb 17.
To examine opinions on trainee independence and attending presence among a cross-section of the general population and explore how perceptions of trust, past experiences, and demographics interacted with comfort consenting to these surgical scenarios.
Mixed-methods METHODS: Based on prior qualitative analysis, we designed a survey of patient preferences and values that focused on trust in healthcare practitioners and processes, which also included comfort ratings of three surgical scenarios (including overlapping surgery). The survey was administered to a sample from the general public using Mechanical Turk. We identified discreet domains of trust and examined the association of responses to these domains with comfort ratings, prior healthcare experiences, and demographics.
We analyzed 225 surveys and identified four patient subgroups based on responses to the surgical scenarios. Subjects that were more comfortable with overlapping surgery were more trusting of trainees and delegation by the attending. Past experiences in healthcare (positive and negative) were associated with multiple domains of trust (in trainees, surgeons, and the healthcare system). Demographics were not predictive of trust responses or comfort ratings.
Patients express varying degrees of comfort with overlapping surgery, and this is not associated with demographics. Past negative experiences have an impact on trust in the healthcare system overall, and trust in trainees specifically predicts comfort with attending absence from the operating room. Efforts to increase patient comfort with overlapping surgery and surgical training should include strategies to address past negative experiences and foster trust in trainees and the delegation process.
IV Laryngoscope, 130:2728-2735, 2020.
调查普通人群对住院医师独立性和手术现场参与度的看法，并探讨信任、既往经验和人口统计学因素如何与同意这些手术场景的意愿产生相互作用。
混合方法。
基于先前的定性分析，我们设计了一项关于患者偏好和价值观的调查，重点关注对医疗保健从业者和流程的信任，同时还包括对三种手术场景（包括重叠手术）的舒适度评估。该调查通过 Mechanical Turk 向普通人群样本进行了管理。我们确定了信任的离散领域，并研究了对这些领域的反应与舒适度评估、既往医疗保健经验和人口统计学因素的关联。
我们分析了 225 份调查，并根据手术场景的回答确定了四个患者亚组。对重叠手术更感舒适的患者对住院医师和主治医生的授权更信任。医疗保健方面的既往经验（积极和消极）与多个信任领域（对住院医师、外科医生和医疗保健系统的信任）相关。人口统计学因素与信任反应或舒适度评估无关。
患者对重叠手术的舒适度表现出不同程度的接受，而这与人口统计学因素无关。过去的负面经历对整个医疗保健系统的信任产生影响，对住院医师的信任具体预测了患者对主治医生离开手术室的接受程度。为提高患者对重叠手术和外科培训的接受程度，应包括解决过去负面经历和培养对住院医师和授权过程的信任的策略。
IV 级喉镜，130：2728-2735，2020。
