Muckler John, Thomas James C, Shinkunas Laura, Kaldjian Lauris C
Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
College of Public Health, University of Iowa, Iowa City, IA, USA.
J Gen Intern Med. 2025 Sep 4. doi: 10.1007/s11606-025-09807-w.
Ethical principles of autonomy and beneficence guide clinical decision making. Little is known about how clinicians prioritize these principles and integrate them with virtue ethics when assessing the ethics of persuasion.
Survey medical students about their attitudes and experiences regarding the use of persuasion by physicians in shared decision making.
Cross-sectional, on-line survey.
Pre-clinical and clinical medical students at one US medical school.
Survey instrument contained 31 items including a three-part clinical vignette, attitudes toward persuasion and ethical principles, experiences observing or participating in persuasion, and demographic information. Bivariate and multivariable analyses were performed, including LASSO regression using a 30-point persuasion score derived from six items.
237 students completed the survey (45% response rate). In general, 55.7% supported persuasion by physicians for the good of the patient's health. Nearly half supported persuasion for an at-risk cardiovascular patient who declines recommendations for walking or statin treatment; 64.1% supported persuasion for a patient with myocardial infarction who wants to leave the hospital against medical advice. While 70.0% believed persuasion is appropriate because it promotes beneficence and nonmaleficence, 16.9% believed persuasion is inappropriate because it disrespects patient autonomy. Most students (81.0%) had seen a good physician role model for persuasion, and 38.0% had willingly participated in persuasion. LASSO regression identified four items contributing positively to the persuasion score (belief that persuasion promotes beneficence/nonmaleficence, observation of a good role model, experience participating in persuasion, male gender) and two negatively (belief that persuasion disrespects patient autonomy, observation of inappropriate use of persuasion).
Medical students vary in attitudes toward persuasion of patients by physicians, and variations are associated with differences in ethical beliefs, clinical experiences, and gender. Education regarding the use of persuasion should address ethical justification, experience, and role-modeling-which can be encompassed by virtue ethics.
自主和行善的伦理原则指导着临床决策。对于临床医生在评估劝说的伦理问题时如何权衡这些原则并将其与美德伦理相结合，我们知之甚少。
调查医学生对医生在共同决策中使用劝说手段的态度和经历。
横断面在线调查。
美国一所医学院的临床前和临床医学生。
调查问卷包含31个项目，包括一个三部分的临床案例、对劝说和伦理原则的态度、观察或参与劝说的经历以及人口统计学信息。进行了双变量和多变量分析，包括使用从六个项目得出的30分劝说得分进行套索回归。
237名学生完成了调查（回复率为45%）。总体而言，55.7%的人支持医生为了患者健康进行劝说。近一半的人支持对拒绝步行或他汀类药物治疗建议的心血管高危患者进行劝说；64.1%的人支持对违背医嘱想要出院的心肌梗死患者进行劝说。虽然70.0%的人认为劝说是合适的，因为它促进了行善和不伤害原则，但16.9%的人认为劝说是不合适的，因为它不尊重患者的自主权。大多数学生（81.0%）见过善于劝说的医生榜样，38.0%的人曾自愿参与过劝说。套索回归确定了对劝说得分有正向贡献的四个项目（认为劝说促进行善/不伤害原则、观察到好的榜样、参与劝说的经历、男性）和两个负向项目（认为劝说不尊重患者自主权、观察到劝说的不当使用）。
医学生对医生劝说患者的态度各不相同，这些差异与伦理信念、临床经验和性别差异有关。关于劝说使用的教育应涉及伦理依据、经验和榜样作用——这些都可以被美德伦理所涵盖。
