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在医疗决策中对临床经验和科学证据的看法:对瑞典医疗保健专业人员的分层随机抽样调查。

Perceptions of Clinical Experience and Scientific Evidence in Medical Decision Making: A Survey of a Stratified Random Sample of Swedish Health Care Professionals.

机构信息

Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA.

Department of Philosophy, Lund University, Lund, Sweden.

出版信息

Med Decis Making. 2024 Apr;44(3):335-345. doi: 10.1177/0272989X241234318. Epub 2024 Mar 16.


DOI:10.1177/0272989X241234318
PMID:38491851
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10988987/
Abstract

BACKGROUND: Evidence-based medicine recognizes that clinical expertise gained through experience is essential to good medical practice. However, it is not known what beliefs clinicians hold about how personal clinical experience and scientific knowledge contribute to their clinical decision making and how those beliefs vary between professions, which themselves vary along relevant characteristics, such as their evidence base. DESIGN: We investigate how years in the profession influence health care professionals' beliefs about science and their clinical experience through surveys administered to random samples of Swedish physicians, nurses, occupational therapists, dentists, and dental hygienists. The sampling frame was each profession's most recent occupational registry. RESULTS: Participants ( = 1,627, 46% response rate) viewed science as more important for decision making, more certain, and more systematic than experience. Differences among the professions were greatest for systematicity, where physicians saw the largest gap between the 2 types of knowledge across all levels of professional experience. The effect of years in the profession varied; it had little effect on assessments of importance across all professions but otherwise tended to decrease the difference between assessments of science and experience. Physicians placed the greatest emphasis on science over clinical experience among the 5 professions surveyed. CONCLUSIONS: Health care professions appear to share some attitudes toward professional knowledge, despite the variation in the age of the professions and the scientific knowledge base available to practitioners. Training and policy making about clinical decision making might improve by accounting for the ways in which knowledge is understood across the professions. HIGHLIGHTS: Study participants, representing 5 health care professions-medicine, nursing, occupational therapy, dentistry, and dental hygiene-viewed science as more important for decision making, more certain, and more systematic than their personal clinical experience.Of all the professions represented in the study, physicians saw the greatest differences between the 2 types of knowledge.The effect of years of professional experience varied but tended to be small, attenuating the differences seen between science and clinical experience.

摘要

背景:循证医学认识到,通过经验获得的临床专业知识对于良好的医疗实践至关重要。然而,目前尚不清楚临床医生对个人临床经验和科学知识如何有助于其临床决策持有何种信念,以及这些信念在不同专业之间如何变化,而这些专业本身也会沿着相关特征(如证据基础)发生变化。

设计:我们通过对瑞典医生、护士、职业治疗师、牙医和牙科保健师的随机样本进行调查,研究专业年限如何影响医疗保健专业人员对科学和临床经验的信念。抽样框架是每个专业最近的职业登记册。

结果:参与者(n=1627,响应率为 46%)认为科学在决策中比经验更重要、更确定、更系统。不同专业之间的差异在系统性方面最大,在所有专业经验水平上,医生认为这两种知识之间的差距最大。专业年限的影响各不相同;它对所有专业的重要性评估几乎没有影响,但在其他方面往往会缩小科学和经验评估之间的差异。在接受调查的 5 个专业中,医生最强调科学而不是临床经验。

结论:尽管专业的年龄和从业者可用的科学知识基础存在差异,但医疗保健专业似乎对专业知识持有一些共同的态度。在制定关于临床决策的培训和政策时,考虑到知识在各专业中的理解方式可能会有所改善。

重点:研究参与者代表 5 个医疗保健专业-医学、护理、职业治疗、牙科和牙科保健-认为科学在决策、更确定和更系统方面比他们的个人临床经验更重要。在所代表的所有专业中,医生看到这两种知识之间的差异最大。专业经验年限的影响各不相同,但往往很小,减弱了科学和临床经验之间的差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e343/10988987/fd5cae5a7865/10.1177_0272989X241234318-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e343/10988987/8219122bea6b/10.1177_0272989X241234318-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e343/10988987/fd5cae5a7865/10.1177_0272989X241234318-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e343/10988987/8219122bea6b/10.1177_0272989X241234318-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e343/10988987/fd5cae5a7865/10.1177_0272989X241234318-fig2.jpg

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本文引用的文献

[1]
Certainty and systematicity of practice-derived evidence matter for its relative importance in professional decision-making: Survey results on the role of proven experience in Swedish medicine, nursing, OT, dentistry, and dental hygiene.

Int J Nurs Stud Adv. 2022-3-17

[2]
Nurse anesthetist attitudes towards parental presence during anesthesia induction- a nationwide survey.

J Adv Nurs. 2022-4

[3]
Trends in Swedish physicians' attitudes towards physician-assisted suicide: a cross-sectional study.

BMC Med Ethics. 2021-7-2

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The epistemic roles of clinical expertise: An empirical study of how Swedish healthcare professionals understand proven experience.

PLoS One. 2021

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Widespread skeptic attitudes among people with epilepsy toward generic antiseizure drugs - A Swedish survey study.

Epilepsy Behav. 2021-1

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Health Policy. 2020-8

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BMJ. 2018-4-25

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BMJ. 2017-5-16

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PLoS One. 2014-5-21

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