Tannou Thomas, Trimaille Hélène, Mathieu-Nicot Florence, Koeberle Séverine, Aubry Régis, Godard-Marceau Aurélie
Geriatrics Department, University Hospital of Besançon, Besançon, France.
Equipe "Ethique et Progrès Médical" Inserm, CIC 1431, Centre d'Investigation Clinique, University Hospital of Besançon, Besançon, France.
Pilot Feasibility Stud. 2020 Dec 14;6(1):194. doi: 10.1186/s40814-020-00742-7.
Shared decision-making is a process that involves collaborative discussions between a patient and a care team to ensure informed healthcare decisions. This process becomes more complex when the older person's decision-making capacities are affected. In these situations, surrogate decision-making processes are used to define a person-centered care plan. Despite these processes, the implementation of the care plan defined in the best interest of the patient may nevertheless be rejected by the patient, particularly in cases of neurocognitive disorders or delirium. This concept of opposition and/or refusal is frequently used in research. This is not yet well understood in the medical literature, and there is a lack of consensus on its definition. We, therefore, explored this concept by defining opposition to diagnostic or therapeutic proposals.
Our pilot study protocol is based on a mixed methodology (epidemiological and qualitative research) to quantify this phenomenon, validate the proposed definition, and explore its core elements. Opposition and refusal of care will be quantified, and semi-structured interviews will be conducted with patients, their relatives, and referring carers. Multidisciplinary meetings that will be associated with these situations will also be observed and analyzed. Methodological approaches that can be used to explore opposition and refusal of care in a scientific, reproducible framework are presented. This methodology considers the specificities of the geriatric, polypathological population with neurocognitive disorders.
Opposition and refusal of care are key concepts in clinical research on ethics, particularly in the geriatric field. These concepts are frequently mentioned in studies involving older patients but have not been specifically defined or studied. This study would undoubtedly lead to greater awareness among professional caregivers and relatives of the significance of such opposition, and more respectful interactions in these complex hospitalization cases.
ClinicalTrial.gov, NCT03373838 . Registered on 14 December 2017.
共同决策是一个患者与护理团队进行协作讨论以确保做出明智医疗决策的过程。当老年人的决策能力受到影响时，这个过程会变得更加复杂。在这些情况下，会采用替代决策过程来制定以患者为中心的护理计划。尽管有这些过程，但符合患者最佳利益的护理计划的实施仍可能被患者拒绝，尤其是在神经认知障碍或谵妄的情况下。这种反对和/或拒绝的概念在研究中经常被使用。在医学文献中，这一点尚未得到很好的理解，并且对于其定义也缺乏共识。因此，我们通过定义对诊断或治疗建议的反对来探讨这一概念。
我们的试点研究方案基于混合方法（流行病学和定性研究），以量化这一现象、验证所提出的定义并探索其核心要素。将对护理的反对和拒绝进行量化，并对患者、其亲属和转诊护理人员进行半结构化访谈。还将观察和分析与这些情况相关的多学科会议。本文介绍了可用于在科学、可重复的框架内探索护理反对和拒绝的方法。该方法考虑了患有神经认知障碍的老年多病患者的特殊性。
护理的反对和拒绝是临床伦理研究中的关键概念，尤其是在老年医学领域。这些概念在涉及老年患者的研究中经常被提及，但尚未得到具体定义或研究。这项研究无疑将使专业护理人员和亲属更加意识到这种反对的重要性，并在这些复杂的住院病例中实现更尊重的互动。
ClinicalTrial.gov，NCT03373838。于2017年（12月）14日注册。 （括号内为补充完整语义所需添加内容）
