以患者为中心的知情同意在妇女健康中的应用：它在产前和产时护理中真的有效吗？
Patient-centred consent in women's health: does it really work in antenatal and intra-partum care?
机构信息
EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, WC1E 6AU, London, UK.
Elizabeth Garrett Anderson Wing, University College London Hospital NHS Foundation Trust, 25 Grafton Way, WC1E 6DB, London, UK.
出版信息
BMC Pregnancy Childbirth. 2022 Feb 25;22(1):156. doi: 10.1186/s12884-022-04493-6.
BACKGROUND
Legal and social changes mean that information sharing and consent in antenatal and intrapartum settings is contentious, poorly understood and uncertain for healthcare professionals. This study aimed to investigate healthcare professionals' views and experiences of the consent process in antenatal and intrapartum care.
METHODS
Qualitative research performed in a large urban teaching hospital in London. Fifteen healthcare professionals (obstetricians and midwives) participated in semi-structured in-depth interviews. Data were collectively analysed to identify themes in the experiences of the consent process.
RESULTS
Three themes were identified: (1) Shared decision-making and shared responsibility -engaging women in dialogue is often difficult and, even when achieved, women are not always able or do not wish to share responsibility for decisions (2) Second-guessing women - assessing what is important to a woman is inherently difficult so healthcare professionals sometimes feel forced to anticipate a woman's views (3) Challenging professional contexts - healthcare professionals are disquieted by consent practice in the Labour ward setting which is often at odds with legal and professional guidance.
CONCLUSIONS
Results suggest that there is a mismatch between what is required of healthcare professionals to effect an antenatal or intrapartum consent process concordant with current legal and professional guidance and what can be achieved in practice. If consent, as currently articulated, is to remain the barometer for current practice, healthcare professionals need more support in ways of enabling women to make decisions which healthcare professionals feel confident are autonomous whatever the circumstances of the consultation.
背景
法律和社会变革意味着，在产前和产时环境中，信息共享和同意是有争议的，医护人员对此理解甚少且不确定。本研究旨在调查医护人员对产前和产时护理中同意过程的看法和经验。
方法
在伦敦的一家大型城市教学医院进行定性研究。15 名医护人员（产科医生和助产士）参与了半结构化深入访谈。对数据进行了集体分析，以确定同意过程经验中的主题。
结果
确定了三个主题：（1）共同决策和共同责任——与女性进行对话往往很困难，即使实现了，女性也并非总是能够或愿意共同承担决策责任；（2）猜测女性——评估对女性重要的是什么本质上是困难的，因此医护人员有时会感到被迫预测女性的观点；（3）具有挑战性的专业环境——医护人员对产房环境中的同意实践感到不安，因为这种实践往往与法律和专业指导相矛盾。
结论
研究结果表明，在产前或产时同意过程方面，医护人员需要符合当前法律和专业指导的要求，与实际情况之间存在不匹配。如果同意（如目前所述）仍然是当前实践的晴雨表，那么医护人员需要更多的支持，以帮助女性做出决策，无论咨询情况如何，医护人员都有信心这些决策是自主的。
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