Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
OhioHealth, Columbus, Ohio, USA.
AJOB Empir Bioeth. 2021 Oct-Dec;12(4):215-226. doi: 10.1080/23294515.2020.1865476. Epub 2020 Dec 31.
This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making.
A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and then quantitatively and qualitatively analyzed to identify actions associated with preference-concordant treatment.
Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment.
Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care.
本研究介绍了一种实证方法，用于研究谨慎在医生临终决策治疗中的作用。
对多中心临终决策研究中 88 例模拟患者就诊的转录本进行混合方法分析。内科、急诊和重症医学的医生被要求评估一位失代偿的晚期癌症患者。就诊记录的转录本进行了编码，以捕捉亚里士多德谨慎概念的行为者、行动和内容，然后进行定量和定性分析，以确定与偏好一致的治疗相关的行动。
关注描述医患互动特征的代码，医生重新陈述患者偏好的代码与避免插管有关。多个代码与偏好一致的治疗的次要措施相关。
可以通过实证方法确定谨慎的行为，关注谨慎的美德的研究可能为临终关怀的评估和培训提供新的途径。
