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“霍布森选择”:急性外科手术中同意问题的定性研究

'Hobson's choice': a qualitative study of consent in acute surgery.

作者信息

Howard Anthony, Webster Jonathan, Quinton Naomi, Giannoudis Peter V

机构信息

Leeds Orthopaedic Trauma Sciences, LGI, University of Leeds, Leeds, UK

Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, Leeds, UK.

出版信息

BMJ Open. 2020 Oct 8;10(10):e037657. doi: 10.1136/bmjopen-2020-037657.

Abstract

OBJECTIVES

The study aimed to understand through qualitative research what patients considered material in their decision to consent to an acute surgical intervention.

PARTICIPANTS, SETTING AND INTERVENTION: The patients selected aged between 18 and 90, having been admitted to a major trauma centre to undergo an acute surgical intervention within 14 days of injury, where English was their first language. Data saturation point was reached after 21 patients had been recruited. Data collection and analysis were conducted simultaneously, through interviews undertaken immediately prior to surgery. The data were coded using NVIVO V.12 software.

RESULTS

The key theme that originated from the data analysis was patients were unable to identify any individual risk that would modify their decision-making process around giving consent. The patient's previous experience and the experience of others around them were a further theme. Patients sensed that there were no non-operative options for their injuries.

CONCLUSION

This is the first study investigating what patient considered a material risk in the consent process. Patients in this study did attribute significance to past experiences of friends and family as material, prompting us to suggest that the surgeon asks about these experiences as part of the consent process. Concern about functional recovery was important to patients but insufficient to stop them from consenting to surgery, thus could not be classified as material risk.

摘要

目的

本研究旨在通过定性研究了解患者在决定同意进行急性外科手术时所认为的重要因素。

参与者、研究背景与干预措施:入选患者年龄在18至90岁之间,因伤在14天内被收治于一家大型创伤中心接受急性外科手术,且以英语为母语。招募21名患者后达到数据饱和点。通过在手术前即刻进行访谈同步收集和分析数据。使用NVIVO V.12软件对数据进行编码。

结果

数据分析得出的关键主题是,患者无法识别任何会改变其同意手术决策过程的个体风险。患者自身既往经历及周围其他人的经历是另一个主题。患者感觉针对其损伤不存在非手术治疗选择。

结论

这是第一项调查患者在同意过程中所认为的重大风险的研究。本研究中的患者确实将朋友和家人的既往经历视为重要因素,这促使我们建议外科医生在同意过程中询问这些经历。对功能恢复的担忧对患者很重要,但不足以阻止他们同意手术,因此不能归类为重大风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5da6/7545640/11526a4b4428/bmjopen-2020-037657f01.jpg

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