Чьи ценности влияют на решения? ↑
meta_eugzol в посте Metapractice (оригинал в ЖЖ)
Насколько в решениях пациентов (на примере решений об окончании жизни) реально проявляются ценности пациентов, а насколько ценности врачей.
Кстати, пользуясь наработками Метапрактика мы можем ответить на такой исследовательский вопрос на основе языкоидного анализа одного представленного от "A" до "Z" сеанса/приёма.
3 комментария
сначала старые сначала новые
Насколько в решениях пациентов (на примере решений об окончании жизни) реально проявляются ценности пациентов, а насколько ценности врачей.
А где ценности родственников/ухаживающих? В большинстве случаев они являются решающими. Пациент, для которого актуально такое решение, обычно физически, и, возможно, когнитивно слаб, для того, чтобы его принять или отстаивать.
Вспоминается уход Стива Андреаса.
мы можем ответить на такой исследовательский вопрос на основе языкоидного анализа одного представленного от "A" до "Z" сеанса/приёма.
Предлагаю считать представленные видео с Линдой таким сеансом.
А где ценности родственников/ухаживающих? В большинстве случаев они являются решающими. Пациент, для которого актуально такое решение, обычно физически, и, возможно, когнитивно слаб, для того, чтобы его принять или отстаивать.
Вспоминается уход Стива Андреаса.
мы можем ответить на такой исследовательский вопрос на основе языкоидного анализа одного представленного от "A" до "Z" сеанса/приёма.
Предлагаю считать представленные видео с Линдой таким сеансом.
An important role for physician values in medical decisions is
not unique to end-of-life decisions. Studies of other kinds of med¬
ical decisions show similar results. For example, in a study of
treatment for bronchogenic carcinoma, the choice of surgery vs
radiation appeared to be influenced more heavily by physician
risk preferences than by patient risk preferences.9 In a study of
cesarean section rates where there were twofold variations in
the use of cesarean section by different obstetricians, the vari¬
ations seemed to reflect idiosyncratic differences among the in¬
dividual physicians rather than any medical or socioeconomic dif¬
ferences among the patients.10 Likewise, studies of racial dispar¬
ities in clinical decision making have found differences in the
treatment of coronary artery disease and chronic renal failure
according to race that cannot be explained by variations in age,
income, type of insurance, or severity of disease.1113
[...]
In one study involving 72
competent patients, physicians discussed the DNR order
with the family rather than the patient in 13 of the cases.16
While family members may convey a sense of the patient's
values and preferences, studies have consistently shown that
people are not very accurate in predicting the treatment
preferences of their family members.17(p9B)
[...]
Treatment of the permanently unconscious patient may be
going through the same transition. As a result of the Quinlan
case in 1976,32 the permanently unconscious are no longer
obligated to receive ventilator-assisted breathing treatment.
Last year, in the Wanglie case, an effort was made by phy¬
sicians to have a ventilator deemed unavailable for a perma¬
nently unconscious patient despite the family's request that
ventilator-assisted breathing be continued.33 The Wanglie
court sided with the family, but it may only be a matter of
time before permanently unconscious patients are denied
long-term ventilator-assisted breathing or other medical care.
[...]
https://sci-hub.tw/https://jamanetwork.com/journals/jama/article-abstract/396570
not unique to end-of-life decisions. Studies of other kinds of med¬
ical decisions show similar results. For example, in a study of
treatment for bronchogenic carcinoma, the choice of surgery vs
radiation appeared to be influenced more heavily by physician
risk preferences than by patient risk preferences.9 In a study of
cesarean section rates where there were twofold variations in
the use of cesarean section by different obstetricians, the vari¬
ations seemed to reflect idiosyncratic differences among the in¬
dividual physicians rather than any medical or socioeconomic dif¬
ferences among the patients.10 Likewise, studies of racial dispar¬
ities in clinical decision making have found differences in the
treatment of coronary artery disease and chronic renal failure
according to race that cannot be explained by variations in age,
income, type of insurance, or severity of disease.1113
[...]
In one study involving 72
competent patients, physicians discussed the DNR order
with the family rather than the patient in 13 of the cases.16
While family members may convey a sense of the patient's
values and preferences, studies have consistently shown that
people are not very accurate in predicting the treatment
preferences of their family members.17(p9B)
[...]
Treatment of the permanently unconscious patient may be
going through the same transition. As a result of the Quinlan
case in 1976,32 the permanently unconscious are no longer
obligated to receive ventilator-assisted breathing treatment.
Last year, in the Wanglie case, an effort was made by phy¬
sicians to have a ventilator deemed unavailable for a perma¬
nently unconscious patient despite the family's request that
ventilator-assisted breathing be continued.33 The Wanglie
court sided with the family, but it may only be a matter of
time before permanently unconscious patients are denied
long-term ventilator-assisted breathing or other medical care.
[...]
https://sci-hub.tw/https://jamanetwork.com/journals/jama/article-abstract/396570
...the variations seemed to reflect idiosyncratic differences among the individual physicians rather than any medical or socioeconomic differences among the patients.
Это и хорошо, что социо-экономические особенности особо не влияли на выбор лечения.
While family members may convey a sense of the patient's values and preferences, studies have consistently shown that people are not very accurate in predicting the treatment preferences of their family members.
Тут как раз обсуждали дела с членами семьи. Члены семьи не могли предугадать выбор больного. Для этого и интересуются, в первую очередь, мнением больного.
Last year, in the Wanglie case, an effort was made by physicians to have a ventilator deemed unavailable for a permanently unconscious patient despite the family's request that ventilator-assisted breathing be continued.
Хотели отключить дыхательный аппарат, но не отключили. Видимо, обозначили свою готовность это сделать для страховой компании, чтобы не получить от нее штраф. А потом, не стали отключать по решению суда. Тут уж страховой компании деваться некуда.