Assessment of decision-making autonomy in chronic pain patients: a pilot study

IF 3 1区 哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-09-18 DOI:10.1186/s12910-024-01096-y
Marguerite d’Ussel, Emmanuelle Sacco, Nathan Moreau, Julien Nizard, Guillaume Durand
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Abstract

Patient decision-making autonomy refers to the patients’ ability to freely exert their own choices and make their own decisions, given sufficient resources and information to do so. In pain medicine, it is accepted that appropriate beneficial management aims to propose an individualized treatment plan shared with the patients, as agents, to help them live as autonomously as possible with their pain. However, are patients in chronic pain centers sufficiently autonomous to participate in the therapeutic decisions that concern them? As this question still remains unanswered, a pilot study was set up to that aim. Over a 2-month period, first-time patients within a tertiary multidisciplinary pain center underwent a systematic evaluation of their autonomy using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), considered the benchmark tool for measuring a patient’s ability to consent to treatment. Demographic data and pain characteristics of the patients were collected and their respective attending pain physicians were asked to clinically assess their patients’ degree of autonomy. Another physician, who had not participated in the initial patient evaluation, subsequently administered the MacCAT-T questionnaire to the same patients. Twenty-seven patients were included during the study period (21 women and 6 men), with an average age of 50 years. The average duration of pain was 8 years. Based on their clinical experience, the 4 different pain physicians in charge of these patients considered that out of 25 assessed patients, 22 of them (89%) had full decision-making capacity, with no deficit in autonomy. According to the MacCAT-T results, only 13 of these 25 patients (48%) had no deficit, while 7 (26%) had a major deficit in autonomy. The only patient characteristic that appeared to be related to autonomy was pain type, specifically nociplastic pain. The average time taken to complete the test was 20 min, and patients were very satisfied with the interview. Results from the present pilot study suggest that patients suffering from chronic pain do not appear to be entirely autonomous in their decision to consent to the proposed treatment plan according to the MacCAT-T questionnaire, and physicians seem to find it difficult to properly assess this competence in a clinical setting. Further studies with larger samples are needed to better evaluate this concept to improve the complex management of these patients.
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评估慢性疼痛患者的自主决策能力:一项试点研究
患者决策自主权是指患者在有足够资源和信息的情况下,自由做出选择和决定的能力。在疼痛医学中,人们普遍认为,适当的有益管理旨在提出个性化的治疗方案,与作为代理人的患者共享,以帮助他们尽可能自主地与疼痛共存。然而,慢性疼痛中心的患者是否有足够的自主权来参与与他们相关的治疗决策?鉴于这一问题仍未得到解答,我们为此开展了一项试点研究。在为期两个月的时间里,一家三级多学科疼痛中心的首次就诊患者使用麦克阿瑟治疗能力评估工具(MacCAT-T)对其自主性进行了系统评估,该工具被认为是衡量患者同意治疗能力的基准工具。研究人员收集了患者的人口统计学数据和疼痛特征,并要求各自的疼痛主治医生对患者的自主程度进行临床评估。另一名未参与患者初步评估的医生随后对相同的患者进行了 MacCAT-T 问卷调查。研究期间共纳入了 27 名患者(21 名女性和 6 名男性),平均年龄为 50 岁。疼痛持续时间平均为 8 年。根据他们的临床经验,负责这些患者的 4 位不同的疼痛科医生认为,在 25 位接受评估的患者中,22 位(89%)具有完全的决策能力,自主性没有缺陷。根据 MacCAT-T 的结果,这 25 名患者中只有 13 人(48%)不存在自主能力缺陷,而 7 人(26%)存在严重的自主能力缺陷。唯一似乎与自主能力有关的患者特征是疼痛类型,特别是非痉挛性疼痛。完成测试的平均时间为 20 分钟,患者对访谈非常满意。本试验研究的结果表明,慢性疼痛患者似乎并不能完全自主地根据 MacCAT-T 问卷决定是否同意建议的治疗方案,而医生似乎也很难在临床环境中正确评估这种能力。为了更好地评估这一概念,改善对这些患者的复杂管理,还需要进行更多的样本研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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