Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
Med Decis Making. 2020 Nov;40(8):1020-1033. doi: 10.1177/0272989X20963042.
Factors other than patient's preference may influence surrogate medical decision making in a culture- and viewpoint-dependent way. We explored the importance hierarchy of potential surrogate medical decision making determinants to Middle-Eastern (ME) and East-Asian (EA) men according to their norm-perception (N-viewpoint), preference as patients (P-viewpoint), and preference as surrogate decision-makers (S-viewpoint).
Each respondent (120 ME, 120 EA) sorted 28 items reflecting potential determinants into a fixed distribution of importance hierarchy according to the three viewpoints. Latent decision making models were explored by by-person factor analysis (Q-methodology).
Six models were identified for each ME and EA viewpoint (total 36). Patient's health-related, patient's preference-related, and society's interests-related determinants were strongly embraced in 34, 3, and zero models and strongly discounted in 2, 5, and 21 models, respectively. Patient's religious/spiritual belief was strongly embraced in 6 EA models compared to 2 ME models and strongly discounted in 2 EA models compared to 5 ME models. Further, family-centric and surrogate's interest-related determinants were strongly embraced in 8 EA models compared to 1 ME model. They were also strongly embraced in 5 P-viewpoint compared to 2 S-viewpoint models and strongly discounted in 4 P-viewpoint compared to 11 S-viewpoint models. Despite the overall predominance of patient's health-related determinants and culture- and viewpoint-dependent differences, Q-methodology analysis identified relatively patient's preference-influenced, religious/spiritual beliefs-influenced, emotion-influenced, and familism-influenced models and showed notable overlap in models.
Patient's health was more important than other potential medical surrogate decision making determinants, including patient's preference, for both ME and EA men and in all viewpoints. The relative importance of some determinants was culture- and viewpoint- dependent and allowed description of different albeit overlapping models.
除了患者的偏好之外，其他因素可能会以文化和观点依赖的方式影响替代医疗决策。我们根据中东（ME）和东亚（EA）男性的规范感知（N 观点）、作为患者的偏好（P 观点）和作为替代决策者的偏好（S 观点），探讨了潜在替代医疗决策制定决定因素的重要性层次。
每位受访者（120 名 ME，120 名 EA）根据三个观点将 28 个反映潜在决定因素的项目按照固定的重要性层次进行排序。通过个体因素分析（Q 方法）探索潜在决策模型。
为每个 ME 和 EA 观点确定了六个模型（共 36 个）。在 34 个模型中，患者的健康相关、患者的偏好相关和社会利益相关的决定因素被强烈接受，而在 2 个和 5 个模型中则被强烈拒绝，在 21 个模型中则被强烈接受。与 2 个 ME 模型相比，患者的宗教/精神信仰在 6 个 EA 模型中被强烈接受，而在 2 个 EA 模型中则被强烈拒绝。此外，在 8 个 EA 模型中，家庭中心和代理人的利益相关决定因素被强烈接受，而在 1 个 ME 模型中则被强烈接受。在 5 个 P 观点模型中，这些因素也被强烈接受，而在 2 个 S 观点模型中则被强烈拒绝，而在 4 个 P 观点模型中，这些因素被强烈拒绝，而在 11 个 S 观点模型中则被强烈拒绝。尽管患者健康相关决定因素占主导地位，而且文化和观点存在差异，但 Q 方法分析确定了相对受患者偏好、宗教/精神信仰、情感和家庭主义影响的模型，并显示出模型之间存在显著重叠。
对于 ME 和 EA 男性以及所有观点来说，患者的健康比其他潜在的医疗替代决策制定决定因素更为重要，包括患者的偏好。一些决定因素的相对重要性取决于文化和观点，允许描述不同但重叠的模型。
