Department of Obstetrics and Gynecology, WellSpan York Hospital, York, Pennsylvania, USA.
Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
AJOB Empir Bioeth. 2020 Oct-Dec;11(4):268-274. doi: 10.1080/23294515.2020.1817174. Epub 2020 Sep 18.
Unplanned cesarean birth is associated with high levels of patient dissatisfaction and negative birth experiences, which in turn can negatively impact birth outcomes. Previous research has demonstrated that issues of physician-patient communication, mistrust, fear of the operating room (OR), and loss of control contribute to patient dissatisfaction with unplanned cesarean birth. We hypothesized that altering the nature and structure of the informed consent prior to the surgery might improve patient satisfaction and birth experience. Specifically, we explored whether educating resident physicians in counseling skills could shift the focus of informed consent from a checklist merely informing the patient of the risks, benefits, and alternatives to a discussion that informs the physician of the patient's concerns and fears. By approaching consent in this manner, the goal of informed consent expands beyond autonomy rights to include beneficence as well. Residents received education to discuss issues of communication, fear, mistrust, and loss of control when seeking consent for an unplanned cesarean birth. Patients were randomized to receive either additional counseling that encouraged a discussion or a standard informed consent for cesarean birth. Participants were interviewed two weeks later and scored their satisfaction using a Likert scale on the four themes: communication, mistrust, fear of OR, and loss of control. Both groups had very high patient satisfaction scores; there was no statistical difference between them. Both groups exhibited significantly higher levels of birth satisfaction than present in prior research. Training residents to discuss these issues while seeking consent for an unplanned cesarean birth may have improved patient satisfaction for all participants in this study. This suggests that educating residents to engage patients in a dialogue during informed consent counseling is more important than a specific script.
计划性剖宫产与患者满意度低和负面分娩体验有关，而这反过来又会对分娩结局产生负面影响。先前的研究表明，医患沟通、不信任、对手术室的恐惧和失去控制等问题是导致患者对计划性剖宫产不满的原因。我们假设在手术前改变知情同意的性质和结构可以提高患者的满意度和分娩体验。具体来说，我们探讨了是否可以通过培训住院医师的咨询技巧，将知情同意的重点从仅仅告知患者风险、益处和替代方案转变为讨论告知医生患者的关注和恐惧。通过这种方式处理同意书，知情同意的目标不仅包括自主权，还包括善行。住院医师接受了关于沟通、恐惧、不信任和失去控制等问题的教育，以获得计划性剖宫产的同意。患者被随机分配接受额外的鼓励讨论的咨询或标准的剖宫产知情同意。参与者在两周后接受了访谈，并使用李克特量表对四个主题（沟通、不信任、对手术室的恐惧和失去控制）的满意度进行了评分。两组患者的满意度评分都非常高；两组之间没有统计学差异。两组患者的分娩满意度均显著高于先前研究中的水平。培训住院医师在寻求计划性剖宫产同意时讨论这些问题可能提高了本研究中所有参与者的患者满意度。这表明，教育住院医师在知情同意咨询期间让患者参与对话比使用特定的脚本更为重要。
