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急诊科广泛同意的可行性、理解性及适用性:一项探索性混合方法研究

Feasibility, comprehension and applicability of broad consent in the emergency department: an exploratory mixed-methods study.

作者信息

Eienbröker Larissa, Fischer-Rosinský Antje, Möckel Martin, Hanses Frank, Hans Felix Patricius, Wolfrum Sebastian, Drepper Johannes, Krüger Daniela, Heinrich Philipp, Schenk Liane, Slagman Anna

机构信息

Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany

Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.

出版信息

J Med Ethics. 2025 Mar 26. doi: 10.1136/jme-2024-110006.

Abstract

BACKGROUND

The German Medical Informatics Initiative (MII) introduced a standardised Broad Consent (BC) form encompassing medical data, insurance data, contact information and biomaterials for health data research. This study assesses the feasibility of MII-BC in emergency departments (EDs), examining patient understanding and identifying implementation facilitators and barriers. Recommendations for implementation of MII-BC in EDs will be derived.

METHODS

Mixed-method data were collected in EDs of four German university hospitals (UHs) using pseudonymised participant observation with a focus on patient perspective and surveys from patients. Data included MII-BC acceptance rates, patient understanding, motivation to consent and implementation facilitators and barriers. Quantitative data were analysed descriptively; qualitative data underwent content analysis with deductive-inductive category formation.

RESULTS

The exploratory study involved 12 participant observations from four tertiary UHs, surfacing five key themes: (1) MII-BC patient information in the ED, (2) facilitators and (3) barriers in obtaining MII-BC in the ED, (4) patient perspectives on MII-BC and (5) recommendations for implementing MII-BC in EDs. Survey results (n=225) showed that most patients (89.8%) demonstrated high understanding of MII-BC patient information. Facilitators include empathetic engagement, clear communication and encouragement for questions. Hindering factors include estimating study time frames, ambient noises and study procedure interruptions. Adequate resources, such as trained staff and suitable premises, are crucial.

CONCLUSION

Implementing MII-BC in the ED is feasible with appropriate resources, though ED-specific challenges must be addressed. Successful MII-BC implementation in EDs hinges on ensuring access to comprehensible information materials, transparent communication and a calm recruitment environment.

TRIAL REGISTRATION NUMBER

DRKS00030054.

摘要

背景

德国医学信息学倡议(MII)引入了一种标准化的广泛同意(BC)表格,涵盖医疗数据、保险数据、联系信息和用于健康数据研究的生物材料。本研究评估了MII-BC在急诊科(ED)的可行性,考察患者的理解情况,并确定实施的促进因素和障碍。将得出在急诊科实施MII-BC的建议。

方法

在四家德国大学医院(UH)的急诊科收集混合方法数据,采用匿名化的参与观察法,重点关注患者视角,并对患者进行调查。数据包括MII-BC的接受率、患者理解情况、同意的动机以及实施的促进因素和障碍。对定量数据进行描述性分析;对定性数据进行内容分析,并形成演绎-归纳类别。

结果

探索性研究包括来自四家三级UH的12次参与观察,揭示了五个关键主题:(1)急诊科的MII-BC患者信息,(2)促进因素,(3)在急诊科获取MII-BC的障碍,(4)患者对MII-BC的看法,(5)在急诊科实施MII-BC的建议。调查结果(n = 225)显示,大多数患者(89.8%)对MII-BC患者信息有较高理解。促进因素包括共情参与、清晰沟通和鼓励提问。阻碍因素包括对研究时间框架的估计、环境噪音和研究程序中断。充足的资源,如训练有素的工作人员和合适的场所,至关重要。

结论

在有适当资源的情况下,在急诊科实施MII-BC是可行的,尽管必须应对急诊科特有的挑战。在急诊科成功实施MII-BC取决于确保获得易懂的信息材料、透明的沟通以及平静的招募环境。

试验注册号

DRKS0003

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