期刊
MEDICAL CARE
卷 43, 期 5, 页码 466-470出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.mlr.0000160415.08497.11
关键词
decision-making; ethics; medical; informed consent; models; theoretical; patient participation; physician-patient relations; qualitative research
Objective: Physicians are encouraged to actively involve patients in clinical decision-making, but this expectation has not been adequately examined from the physicians' perspective. Our objective was to identify and characterize physicians' attitudes toward patient participation in decision-making and to gain insight into how they consequently think about and structure the decision-making process, Design: This was a qualitative cross-sectional study of physicians' reported attitudes and practices. Setting: The study took place in private practice and academic physicians' practices. Participants: A total of 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired, participated in the study. Measurements: We performed a qualitative analysis of semistructured individual interviews. Results: The physicians in this study expressed consistently positive attitudes toward patient participation in medical decision-making. They identified patient autonomy as an essential justification for patient participation but often went beyond an autonomy-based rationale. Several were motivated by the fundamental principle of beneficence as well as their own self-interest in avoiding legal liability. Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process, others took a more collaborative approach, encouraging patients to assume decisional priority. The decision-making process often was modified by patient, physician, and environmental factors. Conclusions: The physicians in this study demonstrated a positive, flexible approach toward including patients in decision-making. A one-dimensional model of shared decision-making based solely on the principle of autonomy fails to account for variability in how physicians allocate decisional priority and is therefore ethically inadequate,
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