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An argumentation theory-based assessment tool for evaluating disinformation in health-related claims. 一个基于论证理论的评估工具,用于评估健康相关索赔中的虚假信息。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-23 DOI: 10.1016/j.pec.2024.108622
Sara Rubinelli, Nicola Diviani

Objective: This study leverages argumentation theory to combat the growing threat of health disinformation by enhancing public competency in evaluating health-related information.

Methods: We systematically analyzed common persuasive tactics used in health disinformation, categorizing them into thematic groups linked to specific argument types. Based on these analyses, we developed critical questions to test the validity and strength of these arguments, resulting in an assessment tool.

Results: The assessment tool, formatted as a flowchart, guides users through targeted critical questions to assess the credibility of health information. It addresses tactics like data misuse, logical fallacies, and emotional manipulation, effectively improving users' ability to identify and resist misleading health claims.

Conclusion: Utilizing argumentation theory offers a structured framework to dissect and counteract persuasive disinformation techniques, thereby boosting public health literacy and empowering informed health decisions. The assessment tool serves as both an immediate practical tool and a long-term educational resource for building cognitive resilience.

Practice implications: Our findings suggest that health institutions should regularly conduct workshops to strengthen public argumentation skills. Accessible online resources and the integration of argumentation theory into educational curricula are recommended to foster critical thinking and discernment of health information, promoting a more informed and engaged public.

目的:本研究利用论证理论,通过提高公众评估健康相关信息的能力,来对抗日益增长的健康虚假信息威胁。方法:我们系统地分析了健康虚假信息中常用的说服策略,并将其分类为与特定论点类型相关的主题组。基于这些分析,我们提出了一些关键问题来测试这些论点的有效性和强度,从而产生了一个评估工具。结果:评估工具,格式化为流程图,引导用户通过有针对性的关键问题,以评估卫生信息的可信度。它解决了数据滥用、逻辑谬误和情绪操纵等策略,有效地提高了用户识别和抵制误导性健康声明的能力。结论:利用论证理论提供了一个结构化的框架来剖析和抵制有说服力的虚假信息技术,从而提高公共卫生素养,增强知情的卫生决策能力。评估工具既是一种即时的实用工具,也是一种建立认知弹性的长期教育资源。实践意义:我们的研究结果表明,卫生机构应定期举办讲习班,以加强公共辩论技能。建议提供可访问的在线资源并将论证理论纳入教育课程,以培养批判性思维和对卫生信息的辨别能力,促进公众更加知情和参与。
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引用次数: 0
Anxiety about artificial intelligence from patient and doctor-physician. 病人和医生对人工智能的焦虑。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-22 DOI: 10.1016/j.pec.2024.108619
Wenyu Li, Xueen Liu

Objective: This paper investigates the anxiety surrounding the integration of artificial intelligence (AI) in doctor-patient interactions, analyzing the perspectives of both patients and healthcare providers to identify key concerns and potential solutions.

Methods: The study employs a comprehensive literature review, examining existing research on AI in healthcare, and synthesizes findings from various surveys and studies that explore the attitudes of patients and doctors towards AI applications in medical settings.

Results: The analysis reveals that patient anxiety encompasses algorithm aversion, robophobia, lack of humanistic care, challenges in human-machine interaction, and concerns about AI's universal applicability. Doctors' anxieties stem from fears of replacement, legal liabilities, emotional impacts of work environment changes, and technological apprehension. The paper highlights the need for patient participation, humanistic care, improved interaction methods, educational training, and policy guidelines to foster public understanding and trust in AI.

Conclusion: The paper concludes that addressing AI anxiety in doctor-patient relationships is crucial for successfully integrating AI in healthcare. It emphasizes the importance of respecting patient autonomy, addressing the lack of humanistic care, and improving patient-AI interaction to enhance the patient experience and reduce medical errors.

Practice implications: The study suggests that future research should focus on understanding the needs and concerns of patients and doctors, strengthening medical humanities education, and establishing policies to guide the ethical use of AI in medicine. It also recommends public education to enhance understanding and trust in AI to improve medical services and ensure professional development and stable work environment for doctors.

目的:本文调查了围绕人工智能(AI)在医患互动中整合的焦虑,分析了患者和医疗保健提供者的观点,以确定关键问题和潜在的解决方案。方法:本研究采用了全面的文献综述,考察了人工智能在医疗保健领域的现有研究,并综合了各种调查和研究的结果,探讨了患者和医生对人工智能在医疗环境中应用的态度。结果:分析显示,患者焦虑主要包括算法厌恶、机器人恐惧症、人文关怀缺失、人机交互挑战以及对人工智能普遍适用性的担忧。医生的焦虑源于对替代的恐惧、法律责任、工作环境变化对情绪的影响以及对技术的担忧。本文强调了患者参与、人文关怀、改进互动方法、教育培训和政策指导的必要性,以促进公众对人工智能的理解和信任。结论:本文得出结论,解决医患关系中的人工智能焦虑对于成功将人工智能融入医疗保健至关重要。它强调尊重患者的自主权,解决人文关怀的缺失,改善患者与人工智能的互动,以增强患者体验,减少医疗差错。实践意义:研究建议未来的研究应侧重于了解患者和医生的需求和担忧,加强医学人文教育,并制定政策指导人工智能在医学中的道德使用。它还建议进行公众教育,以增强对人工智能的理解和信任,以改善医疗服务,确保医生的专业发展和稳定的工作环境。
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引用次数: 0
The argumentative role of patient companions in (shared) decision-making. 患者同伴在(共同)决策中的争论作用。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-22 DOI: 10.1016/j.pec.2024.108623
Lotte van Poppel, Roosmaryn Pilgram

Objective: This study aims to examine the type of involvement of patient companions in the argumentative exchanges in consultations and explore when their contributions should be taken into account in shared decision-making (SDM).

Methods: A qualitative analysis was carried out using transcribed medical consultations (N = 10) between health professionals (doctors at a regional Dutch hospital), adult patients and informal patient companions. Insights from argumentation theory were used to develop an inventory of twelve theoretically distinct discussion situations involving patient companions, distinguishing possible discussion roles, disagreement types and coalition formations.

Results: Consultations contained on average 4.3 discussion situations. In most discussions (37.21 %) the health professional adopted a standpoint, and the patient and their companion only expressed doubt. More complex cases occurred when one of the three parties, including the companion, opposed opinions of the other parties (in 34.88 % of the situations found) and when coalitions were formed (possible in 18.60 % of the situations found). We found that disagreements occurred or were anticipated by all three parties and involved standpoints about the diagnosis as well as treatment options.

Conclusion: Using the pragma-dialectical argumentation theory as an analytical framework reveals that patient companions can substantially influence treatment decision-making during medical consultation. This influence is contingent upon the specific role they assume in the discussion, the type of disagreement with the health professional and patient, and the formation of coalitions with these parties.

Practice implications: The contributions by patient companions should be considered in SDM if the companion forms a coalition with the patient. If the companion does not form a coalition, the contributions might have a bearing on SDM as well, but their acceptability and relevance for the treatment decision should be checked by the health professional. In general, it is desirable to explicitly establish the role of patient companions in consultations.

目的:本研究旨在考察患者同伴在会诊辩论交流中的参与类型,并探讨在共同决策(SDM)中何时应考虑他们的贡献。方法:采用卫生专业人员(荷兰一家地区医院的医生)、成年患者和非正式患者同伴之间的医疗咨询记录(N = 10)进行定性分析。从论证理论的见解被用来开发12个理论上不同的讨论情况的清单,涉及患者同伴,区分可能的讨论角色,分歧类型和联盟形成。结果:咨询平均包含4.3个讨论情境。在大多数讨论(37.21 %)中,卫生专业人员采取了立场,而患者及其同伴仅表示怀疑。更复杂的情况发生在三方中的一方,包括同伴,反对其他各方的意见(34.88 %的情况)和联盟形成(可能在18.60 %的情况下发现)。我们发现,分歧发生或预期的所有三方和涉及立场的诊断和治疗方案。结论:以语用-辩证论证理论为分析框架,发现患者陪伴对医疗会诊过程中的治疗决策具有实质性影响。这种影响取决于他们在讨论中所扮演的具体角色,与卫生专业人员和患者的分歧类型,以及与这些各方形成的联盟。实践启示:如果患者同伴与患者形成联盟,在SDM中应考虑患者同伴的贡献。如果伴侣没有形成一个联盟,这些贡献也可能对SDM有影响,但它们的可接受性和与治疗决策的相关性应由卫生专业人员检查。一般来说,明确确立患者同伴在会诊中的作用是可取的。
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引用次数: 0
Personalized patient education for subacromial pain syndrome: The role of and spiritual alignment. 肩峰下疼痛综合征的个性化患者教育:作用和精神校准。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-20 DOI: 10.1016/j.pec.2024.108631
Muhammad Taufiqurrahman, Tamama Rofiqah, Tamama Hafizah
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引用次数: 0
Enhancing gender sensitivity in transgender and gender-diverse patient communication. 提高跨性别和性别多样化患者沟通中的性别敏感性。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-19 DOI: 10.1016/j.pec.2024.108621
Elni Yakub, Isnaria Rizki Hayati, Rikas Saputra, Yenni Lidyawati

This article examines the communication preferences of transgender and genderdiverse individuals in the health system context. Findings suggest the importance of gender sensitivity and confident communication styles in improving patient experience. The article recommends case-based training to understand the dynamics of intersectionality and the development of communication aids to improve health literacy. This study highlights the need for longitudinal research to deepen understanding of changing communication preferences in this group.

本文考察了卫生系统背景下跨性别和性别多样化个体的沟通偏好。研究结果表明,性别敏感性和自信的沟通方式对改善患者体验的重要性。这篇文章建议进行基于案例的培训,以了解相互交织的动态,并开发传播工具,以提高卫生素养。这项研究强调了纵向研究的必要性,以加深对这一群体中不断变化的沟通偏好的理解。
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引用次数: 0
Shared decision-making, anxiety, and post-traumatic growth among parents in the context of their child's medical care: The moderating role of parental style. 共同决策,焦虑和创伤后成长的父母在他们的孩子的医疗护理背景:父母风格的调节作用。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-19 DOI: 10.1016/j.pec.2024.108620
Ofir Negri-Schwartz, Tal Shilton, Mariela Mosheva, Doron Gothelf, Ilanit Hasson-Ohayon

Aim: The importance of parents' involvement in their child's medical care has been extensively discussed in the literature, and studies have indicated the need to expand the active role of parents in decision-making processes regarding such care. However, parents' actual wish to be active and informed in this context remains underexplored. The aim of the current study was to explore this gap by investigating the association between parents' shared decision-making (SDM) experience and their well-being during the course of their child's medical care, with a focus on parents' clinical decision-making style as a possible moderator.

Method: A total of 150 parents of children under the age of 18, who utilized various medical care services, participated in the study.

Results: Shared decision-making was found to be associated with parents' anxiety levels during their child's medical treatment, as well as with their post-traumatic growth (PTG). A moderating effect of clinical decision-making style was also found; namely, the relations between SDM, anxiety during the child's treatment, and PTG were different among parents with a passive style than among parents with a shared-active style.

Conclusions: The findings emphasize the personalized nature of SDM, suggesting that its benefits are associated with parental preferences and attitudes. Healthcare professionals should assess parents' actual desire to be involved in SDM in order to tailor services effectively.

目的:父母参与孩子医疗护理的重要性在文献中得到了广泛的讨论,研究表明有必要扩大父母在此类护理决策过程中的积极作用。然而,父母在这方面积极主动和知情的实际愿望仍未得到充分探讨。本研究的目的是通过调查在孩子医疗过程中父母共同决策(SDM)经验与他们的幸福感之间的关系来探索这一差距,重点关注父母的临床决策风格作为可能的调节因素。方法:共有150名18岁以下儿童的父母参与了研究,他们使用了各种医疗服务。结果:发现共同决策与父母在孩子治疗期间的焦虑水平以及他们的创伤后成长(PTG)有关。临床决策风格也有调节作用;即被动型父母与共同主动型父母的SDM、治疗期间焦虑、PTG之间的关系存在差异。结论:研究结果强调了SDM的个性化本质,表明其益处与父母的偏好和态度有关。医疗保健专业人员应该评估家长参与SDM的实际愿望,以便有效地定制服务。
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引用次数: 0
Equity in breast density notification in Australia: A focus group study exploring the impact and needs amongst culturally and linguistically diverse (CALD) women. 澳大利亚乳腺密度通知的公平性:一项探讨文化和语言多样性(CALD)妇女的影响和需求的焦点小组研究。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-19 DOI: 10.1016/j.pec.2024.108628
Brooke Nickel, Claire Hudson, Jennifer Isautier, Kirsten McCaffery, Allan Ben Smith, Paula Legerton, Tong Li, Shu Wang, Nehmat Houssami

Objectives: Previous research suggests a one-size-fits-all approach to breast density notification may disadvantage culturally and linguistically diverse (CALD) women. This study aimed to qualitatively explore CALD women's understanding and views of breast density, attitudes towards health services access, acceptability of notification and preferences for breast density communication ahead of population-based notification in Australia.

Methods: Online focus groups were conducted with CALD women of breast screening age (40-74 years) who spoke one of the five languages with the lowest English proficiency in Australia (Korean, Mandarin, Cantonese, Vietnamese and Arabic). Focus group sessions were in-language and incorporated an evidence-based presentation interspersed with group discussions which were audio-recorded, transcribed and analysed thematically.

Results: Thematic analysis revealed four themes indicating participants had overall strong desires to be informed of breast density, despite some associated worry. CALD women may also face significant barriers to understanding and accessing breast density information and seeking supplemental screening.

Conclusions: Although CALD women have a strong desire to be notified of their breast density, increased anxiety and confusion may exacerbate health inequalities and barriers women from these communities already face.

Practice implications: This study highlights the need for careful consideration of breast density and supplemental screening communications for CALD women.

目的:先前的研究表明,一种适用于所有人的乳房密度通知方法可能不利于文化和语言多样化(CALD)的女性。本研究旨在定性地探讨澳大利亚CALD妇女对乳房密度的理解和看法、对获得保健服务的态度、通知的可接受性以及在以人口为基础的通知之前进行乳房密度通报的偏好。方法:在线焦点小组对处于乳腺筛查年龄(40-74岁)的CALD女性进行了调查,这些女性的英语水平在澳大利亚最低的五种语言(韩语、普通话、广东话、越南语和阿拉伯语)中选择一种。焦点小组会议以语文进行,包括以证据为基础的介绍,并穿插小组讨论,这些讨论被录音、转录和按主题进行分析。结果:主题分析揭示了四个主题,表明参与者总体上强烈希望了解乳房密度,尽管有一些相关的担忧。CALD妇女在理解和获取乳腺密度信息以及寻求补充筛查方面也可能面临重大障碍。结论:尽管CALD妇女强烈希望被告知其乳房密度,但焦虑和困惑的增加可能会加剧这些社区妇女已经面临的健康不平等和障碍。实践意义:本研究强调了CALD妇女需要仔细考虑乳房密度和补充筛查沟通。
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引用次数: 0
Effects of reasoned treatment decision-making on parent-related outcomes: Results from a video-vignette experiment in neonatal care. 合理的治疗决策对父母相关结局的影响:新生儿护理视频实验的结果。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-18 DOI: 10.1016/j.pec.2024.108625
Nanon H M Labrie, Anne A M W van Kempen, Marleen Kunneman, Sylvia A Obermann-Borst, Liesbeth M van Vliet, Nicole R van Veenendaal

Objective: To examine the effects of clinicians' provision of (un)reasonable arguments on parent-related outcomes in neonatal (intensive) care (NICU), starting from the NICU Communication Framework.

Methods: A video-vignette experiment, in which we systematically varied clinicians' use of (reasonable, unreasonable, no) argumentation across two non-acute and two acute decision-making scenarios (3×4 design). Reasonable arguments were medically appropriate and constructive reasons to support the treatment plan, as defined by an expert panel. Based on argumentation theory, unreasonable arguments included hindering appeals to authority or the self-evident nature of the treatment plan. Parents of preterm infants completed an online survey, viewing 1 of 12 video-vignettes and answering questions pertaining to their communication stress, understanding, agreement, participation in communication, empowerment, trust and satisfaction with communication.

Results: N = 163 parents completed the full survey. We found statistically significant (p < 0.001) and large (η2: 0.13-0.38) effects of clinicians' use of argumentation across all parent-related outcomes. Reasonable argumentation led to lower communication stress and higher understanding, agreement, participation in communication, empowerment, trust, and satisfaction with communication than no argumentation. In turn, no argumentation led to improved outcomes compared to unreasonable argumentation. This pattern was similar across non-acute and acute scenarios.

Conclusion: Clinicians' use of reasonable argumentation has a consistently strong and positive impact on parent-related outcomes in neonatal care.

Practice implications: We argue that reasoned decision-making should be considered a good clinical practice, core to patient-centered communication. Our findings provide a starting point for (1) determining good argumentative practices and (2) designing evidence-based clinical argumentation trainings.

目的:从新生儿重症监护(NICU)沟通框架出发,探讨临床医生提供(不)合理论点对新生儿重症监护(NICU)父母相关结局的影响。方法:通过视频小片段实验,我们系统地改变了临床医生在两种非急性和两种急性决策情景(3×4设计)中(合理、不合理、不合理)论证的使用。根据专家小组的定义,合理的论据是医学上适当的和建设性的理由来支持治疗计划。根据论证理论,不合理的论证包括对权威的阻碍性诉求或治疗方案的自明性。早产儿的父母完成了一项在线调查,观看了12个视频片段中的1个,并回答了关于他们的沟通压力、理解、同意、参与沟通、授权、信任和沟通满意度的问题。结果:N = 163名家长完成了完整的调查。我们发现临床医生在所有与父母相关的结果中使用论证的影响具有统计学意义(p 2:0.13-0.38)。合理的辩论比不辩论能降低沟通压力,提高理解、同意、参与沟通、授权、信任和对沟通的满意度。反过来,与不合理的争论相比,没有争论会导致更好的结果。这种模式在非急性和急性情况下相似。结论:临床医生使用合理的论证对新生儿护理中与父母相关的结果具有一贯强烈和积极的影响。实践启示:我们认为理性决策应被视为良好的临床实践,以患者为中心的沟通的核心。我们的研究结果为(1)确定良好的论证实践和(2)设计循证临床论证培训提供了起点。
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引用次数: 0
Patient at community clinics: Recommendations for advancing health literacy. 社区诊所的病人:关于提高卫生素养的建议。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-17 DOI: 10.1016/j.pec.2024.108618
Michelle Palmborg, Carolina Fernandez-Branson, Luisa Pessoa-Brandao

Objective: This study aimed to assess community clinics in enhancing health literacy among underserved patients. We focus on patient-provider communication at these clinics to understand how this communication may foster or hinder health literacy and how the organizational health literacy of clinics may be improved.

Methods: We surveyed 303 patients at three community clinics to evaluate providers' communication behaviors related to health literacy. The city health department entered surveys into SurveyMonkey™ and analyzed them using Stata/SE™. The analysis included frequencies of all variables for all participants and by clinic. Qualitative methods were also used.

Results: Community clinics are trusted care sources; however, around 13 % of patients reported rarely or never being encouraged to ask questions, 20 % reported providers spoke too fast, and 17 % reported that medical staff were not always informative. Patients needing an interpreter reported more communication problems than those not requiring one, making these results more salient.

Conclusions: Community clinics serving low-income patients can enhance personal and organizational health literacy by improving patient-provider communication such as active listening, encouraging patients to ask questions, and addressing language barriers.

Practice implications: Advancing health literacy impacts community and public health initiatives, improves health disparities, builds patient-provider trust, and improves health systems.

目的:本研究旨在评估社区诊所在提高服务不足患者健康素养方面的作用。我们将重点放在这些诊所的医患沟通上,以了解这种沟通如何促进或阻碍健康素养,以及如何改善诊所的组织健康素养。方法:对3家社区诊所的303名患者进行问卷调查,评估服务提供者与健康素养相关的沟通行为。市卫生部门将调查输入SurveyMonkey™,并使用Stata/SE™进行分析。分析包括所有参与者和诊所的所有变量的频率。定性方法也被采用。结果:社区诊所是值得信赖的医疗资源;然而,大约13% %的患者报告很少或从未被鼓励提问,20% %的患者报告提供者说话太快,17% %的患者报告医务人员并不总是提供信息。需要翻译的患者比不需要的患者报告了更多的沟通问题,使得这些结果更加突出。结论:为低收入患者服务的社区诊所可以通过改善医患沟通(如积极倾听、鼓励患者提问和解决语言障碍)来提高个人和组织的健康素养。实践意义:提高卫生素养影响社区和公共卫生举措,改善卫生差距,建立患者与提供者之间的信任,并改善卫生系统。
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引用次数: 0
Development and testing of a generic patient decision aid for end-of-life care. 开发和测试一种通用的临终关怀患者决策辅助工具。
IF 2.9 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-12-17 DOI: 10.1016/j.pec.2024.108608
Hanne Irene Jensen, Sarah Leeth Hansen Farmer, Lillian Oxholm Skaarup, Anders Løkke, Anette Hygum, Mette Jo Ipsen, Lisbeth Høilund Gamst, Maybritt Brunsgård Klausen

Objectives: The objective of this study was to develop and test a patient decision aid for end-of-life care to be used when some or all life-sustaining treatments have been withheld or withdrawn.

Methods: A multi-professional, multi-sectorial group together with patients and relatives used a systematic process to develop and test the patient decision aid, including alpha and beta testing.

Results: Healthcare professionals, patients and relatives were involved in the development and testing. The final Decision Helper included three areas with nine options: follow-up (outpatient clinic and general practitioner), palliative care (primary care, specialised palliative care team, hospital admission and hospice) and treatment level (intensive care, resuscitation attempt and nutrition via feeding tube). Most participants agreed that the amount of information in the Decision Helper was appropriate, that it clearly presented benefits and disadvantages and that it was useful in the value clarification process, helping to verbalise preferences and what is most important for patients.

Conclusions: Most patients and healthcare professionals found that the decision aid would be helpful in facilitating shared decision-making in an end-of-life conversation.

Practice implications: The decision aid will be usable in different healthcare setting ensuring that end-of-life care is in accordance with patients' wishes.

目的:本研究的目的是开发和测试患者临终关怀的决策辅助工具,当部分或所有维持生命的治疗被拒绝或撤回时使用。方法:一个多专业、多部门的小组与患者和家属一起,采用系统的过程来开发和测试患者决策辅助工具,包括alpha和beta测试。结果:医疗保健专业人员、患者和家属参与了开发和测试。最终决策助手包括三个领域,共有九个选项:随访(门诊诊所和全科医生)、姑息治疗(初级保健、专门姑息治疗小组、住院和临终关怀)和治疗水平(重症监护、复苏尝试和通过喂食管营养)。大多数与会者同意,决策助手的信息量是适当的,它清楚地展示了利弊,它在价值澄清过程中是有用的,有助于用语言表达偏好和对患者最重要的是什么。结论:大多数患者和医疗保健专业人员发现,决策援助将有助于促进共同决策在临终谈话。实践意义:决策援助将在不同的医疗保健设置确保临终关怀是按照病人的意愿使用。
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引用次数: 0
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Patient Education and Counseling
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