Wu W C, Pearlman R A
University of Washington, Seattle.
J Gen Intern Med. 1988 Jan-Feb;3(1):9-14. doi: 10.1007/BF02595749.
Informed participation in medical decisions is important because it demonstrates respect for the ethical principle of individual autonomy and increases the likelihood of reaching therapeutic goals. Twenty hospitalized patients were randomly selected and observed for six and a half hours to assess the degree to which informed participation was possible with diagnostic and therapeutic procedures. Resident physicians and patients were then interviewed about the rationale, benefit, risk, and alternative for each observed procedure. Commonly observed activities were injecting and giving oral medications, and performing invasive diagnostic procedures. Clinicians' communication involved rationale (43%) more often than benefits (34%), risks (14%), and alternatives (12%). Communication was similar when the procedures proposed were important and risky. Residents' and patients' interviews demonstrated limited congruence in shared understanding of rationale (57%), benefit (45%), risk (19%), and alternatives (25%). These results suggest that clinicians selectively impart information essential for informed patient participation, and highlight areas of clinician-patient communication in need of attention.
知情参与医疗决策很重要，因为它体现了对个体自主这一伦理原则的尊重，并增加了实现治疗目标的可能性。随机挑选了20名住院患者，对其进行了六个半小时的观察，以评估在诊断和治疗程序中实现知情参与的程度。随后，就每项观察到的程序的基本原理、益处、风险和替代方案，对住院医师和患者进行了访谈。常见的观察活动包括注射和口服给药，以及进行侵入性诊断程序。临床医生在沟通中提及基本原理（43%）的频率高于益处（34%）、风险（14%）和替代方案（12%）。当提议的程序既重要又有风险时，沟通情况类似。住院医师和患者的访谈表明，在对基本原理（57%）、益处（45%）、风险（19%）和替代方案（25%）的共同理解方面，一致性有限。这些结果表明，临床医生有选择地提供患者知情参与所需的关键信息，并突出了医患沟通中需要关注的领域。
