The Healthcare Improvement Studies (THIS) Institute, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK.
J Eval Clin Pract. 2023 Oct;29(7):1127-1134. doi: 10.1111/jep.13882. Epub 2023 Jun 20.
In order for patients to make autonomous decisions in a healthcare setting, they must understand relevant information. There is, however, a lack of consensus on how understanding should be defined or assessed in this context, despite the fact that in practice doctors are regularly required to judge whether a patient has understood medical information. Current accounts of patient decision-making often focus on the information which needs to be disclosed to the patient to support their autonomous decision-making. Far less attention has been afforded to questions about how we might determine whether a patient has understood the information disclosed to them. Theoretical approaches to the concept of understanding in this context, and practically useful frameworks for assessing it, are lacking. In this paper, I use a number of hypothetical clinical situations to explore the conditions that are required for a patient to adequately understand information in medical decision-making. Drawing upon the wider philosophical literature, I propose a number of criteria which are necessary for understanding in a medical context: patients must (1) grasp a body of information which (2) reasonably reflects a responsible body of medical professionals' best estimate of the truth, (3) to a degree which meets a context-specific threshold. These criteria may be helpful in guiding assessments of patient understanding in clinical practice.
为了使患者能够在医疗环境中做出自主决策，他们必须理解相关信息。然而，尽管在实践中医生经常需要判断患者是否理解了医疗信息，但对于在这种情况下应如何定义或评估理解却缺乏共识。目前关于患者决策的论述通常侧重于需要向患者披露以支持其自主决策的信息。而对于我们如何确定患者是否理解了向他们披露的信息，关注则要少得多。在这种情况下，缺乏对理解概念的理论方法以及实用的评估框架。在本文中，我使用了一些假设的临床情况来探讨患者在医疗决策中充分理解信息所需的条件。借鉴更广泛的哲学文献，我提出了一些在医学背景下理解所必需的标准：患者必须 (1) 掌握反映负责任的医疗专业人员对真相的最佳估计的信息体，(2) 达到特定于上下文的阈值。这些标准可能有助于指导临床实践中对患者理解的评估。
