一项关于儿童牙科知情同意全球实践的试点研究。

A pilot study on the global practice of informed consent in paediatric dentistry.

作者信息

Potgieter Nicoline, Bridge Gemma, Elfrink Marlies, Folayan Morenike Oluwatoyin, Gao Sherry S, Groisman Sonia, Jawdekar Ashwin, Kemoli Arthur M, Lim David, Ly Phuong, Mani Shani A, Masumo Ray, Monteiro Joana, Muasya Marjorie K, Qureshi Ambrina, Tinanoff Norman

机构信息

Department of Orthodontics & Paediatric Dentistry, University of the Western Cape, Cape Town, South Africa.

School of Earth and Environment, The University of Leeds, Leeds, United Kingdom.

出版信息

Front Oral Health. 2024 Mar 1;5:1298277. doi: 10.3389/froh.2024.1298277. eCollection 2024.

DOI:10.3389/froh.2024.1298277

PMID:38496332

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10940476/

Abstract

BACKGROUND

Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment-and has specific relevance with SDF/ SF treatments.

METHODS

The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared.

RESULTS

Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the "best interest" of the patient.

CONCLUSION

It is recommended that it is clarified globally when a dentist may act in the "best interest" of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries.

摘要

背景

鼓励在疾病病程早期进行口腔治疗以获得更好的健康结果。获得知情同意是医疗实践的重要组成部分，它保护患者的合法权利并指导医学的道德实践。在实践中，同意在不同背景下有不同含义。氟化亚锡（SDF）和氟化银（SF）正成为治疗龋损的常用且经济有效的方法，然而，会导致治疗的病损出现黑色变色。获得知情同意和赞同对于任何牙科治疗都至关重要，并且与SDF/SF治疗具有特定相关性。

方法

本文旨在描述一些国家牙科护理的知情同意规定，重点关注儿童和有特殊医疗需求的患者。一项在线调查被分享给来自13个国家的方便样本的牙科专业人员。对信息进行了探究并比较了同意的过程。

结果

研究结果表明，医疗实践中的知情同意存在差异。在坦桑尼亚、南非、印度、肯尼亚、马来西亚和巴西，年龄是判断行为能力和自我同意能力的决定因素。在其他国家，除年龄外还会考虑其他因素。例如，在新加坡、英国和美国，适用吉利克能力原则。许多国家的法律法规未明确规定牙医何时可以推翻一般同意以采取符合患者“最佳利益”的行动。