Tại sao các bác sĩ nội trú lại ưu tiên phương pháp ra quyết định gia trưởng? Một nghiên cứu phỏng vấn

BMC Medical Education - Tập 22 Số 1
Ellen Driever1, Ivo M. Tolhuizen2, Robbert Duvivier3, Anne M. Stiggelbout4, Paul Brand5
1Department of Innovation and Research, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, the Netherlands
2Faculty of Medical Science, University Medical Centre of Groningen, Groningen, the Netherlands
3Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, Groningen, the Netherlands
4Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
5Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, the Netherlands

Tóm tắt

Tóm tắt Nền tảng Mặc dù phương pháp ra quyết định chung được các tổ chức bệnh nhân, nhà nghiên cứu và các chuyên gia y tế ủng hộ như là mô hình lý tưởng cho việc chăm sóc bệnh nhân, nhưng việc áp dụng nó trong thực tiễn hàng ngày vẫn còn hạn chế. Chúng tôi đã chỉ ra rằng các bác sĩ nội trú thường ưu tiên phương pháp ra quyết định gia trưởng hơn so với các giám sát viên của họ. Vì cả quan điểm của các bác sĩ nội trú về quy trình ra quyết định trong các buổi tư vấn y tế và lý do cho 'sự ưu tiên gia trưởng' của họ đều chưa được biết đến, nghiên cứu này đã khám phá quan điểm của các bác sĩ nội trú về quy trình ra quyết định trong các cuộc gặp gỡ y tế và các yếu tố ảnh hưởng đến nó. Phương pháp Chúng tôi đã phỏng vấn 12 bác sĩ nội trú từ nhiều chuyên ngành tại một bệnh viện giảng dạy lớn ở Hà Lan trong giai đoạn 2019–2020, khám phá cách họ liên quan đến bệnh nhân trong các quyết định. Tất cả các bác sĩ nội trú tham gia đều đã cung cấp sự đồng ý bằng văn bản. Phân tích dữ liệu diễn ra đồng thời với quá trình thu thập dữ liệu theo quy trình lặp đi lặp lại, mà thông báo cho việc điều chỉnh hướng dẫn chủ đề phỏng vấn khi cần thiết. Phân tích so sánh liên tục đã được sử dụng để phát triển các chủ đề. Chúng tôi đã ngừng thu thập dữ liệu khi đạt được đủ thông tin.

Từ khóa


Tài liệu tham khảo

Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. Patient Educ Couns. 2012;86(1):9–18.

Pollard S, Bansback N, Bryan S. Physician attitudes toward shared decision making: A systematic review. Patient Educ Couns. 2015;98(9):1046–57.

Driever EM, Stiggelbout AM, Brand PLP. Shared decision making: Physicians' preferred role, usual role and their perception of its key components. Patient Educ Couns. 2020;103(1):77–82.

Joseph-Williams N, Lloyd A, Edwards A, Stobbart L, Tomson D, Macphail S, et al. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ. 2017;357:j1744.

van der Weijden T, Post H, Brand PLP, van Veenendaal H, Drenthen T, van Mierlo LA, et al. Shared decision making, a buzz-word in the Netherlands, the pace quickens towards nationwide implementation. Z Evid Fortbild Qual Gesundhwes. 2017;123-124:69–74.

Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891.

Stiggelbout AM, Pieterse AH, De Haes JC. Shared decision making: Concepts, evidence, and practice. Patient Educ Couns. 2015;98(10):1172–9.

Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267(16):2221–6.

Joosten EA, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CP, de Jong CA. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom. 2008;77(4):219–26.

Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2013;70(4):351–79.

Stacey D, Legare F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431.

Couet N, Desroches S, Robitaille H, Vaillancourt H, Leblanc A, Turcotte S, et al. Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expect. 2015;18(4):542–61.

van Veenendaal H, van der Weijden T, Ubbink DT, Stiggelbout AM, van Mierlo LA, Hilders C. Accelerating implementation of shared decision-making in the Netherlands: an exploratory investigation. Patient Educ Couns. 2018.

Greenhalgh T, Howick J, Maskrey N. Evidence based medicine: a movement in crisis? BMJ. 2014;348:g3725.

Gartner FR, Portielje JE, Langendam M, Hairwassers D, Agoritsas T, Gijsen B, et al. Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case. BMJ Open. 2019;9(12):e032483.

Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014;312(13):1295–6.

Bossen JKJ, van der Weijden T, Driessen EW, Heyligers IC. Experienced barriers in shared decision-making behaviour of orthopaedic surgery residents compared with orthopaedic surgeons. Musculoskeletal Care. 2019;17(2):198–205.

Thistlethwaite J, Heal C, Tie RN, Evans R. Shared decision making between registrars and patients--web based decision aids. Aust Fam Physician. 2007;36(8):670–2.

Kheirkhah F, Larijani RM, Faramarzi M, Yadollahpour MH, Khafri S. Psychological predictors of medical residents' perspectives on shared decision-making with patients: a cross-sectional study. BMC Med Educ. 2020;20(1):251.

Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis: SAGE publications; 2006.

Watling CJ, Lingard L. Grounded theory in medical education research: AMEE Guide No. 70. Med Teach. 2012;34(10):850–61.

Finlay L. "Outing" the researcher: the provenance, process, and practice of reflexivity. Qual Health Res. 2002;12(4):531–45.

Schoenfeld EM, Goff SL, Elia TR, Khordipour ER, Poronsky KE, Nault KA, et al. A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education. J Grad Med Educ. 2018;10(1):43–50.

Legare F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood). 2013;32(2):276–84.

Boland L, Graham ID, Legare F, Lewis K, Jull J, Shephard A, et al. Barriers and facilitators of pediatric shared decision-making: a systematic review. Implement Sci. 2019;14(1):7.

Zeuner R, Frosch DL, Kuzemchak MD, Politi MC. Physicians' perceptions of shared decision-making behaviours: a qualitative study demonstrating the continued chasm between aspirations and clinical practice. Health Expect. 2015;18(6):2465–76.

Savelberg W, Boersma LJ, Smidt M, Goossens MFJ, Hermanns R, van der Weijden T. Does lack of deeper understanding of shared decision making explains the suboptimal performance on crucial parts of it? An example from breast cancer care. Eur J Oncol Nurs. 2019;38:92–7.

Dowson J. Transferring knowledge into practice? Exploring the feasibility of action learning for improving knowledge, skills and confidence in clinical communication skills. BMC Med Educ. 2019;19(1):37.

van den Eertwegh V, van Dalen J, van der Vleuten C, Scherpbier A. Residents' perceived barriers to communication skills learning: comparing two medical working contexts in postgraduate training. Patient Educ Couns. 2014;95(1):91–7.

Tilburt JC, Mangrulkar RS, Goold SD, Siddiqui NY, Carrese JA. Do we practice what we preach? A qualitative assessment of resident-preceptor interactions for adherence to evidence-based practice. J Eval Clin Pract. 2008;14(5):780–4.

Thor J, Olsson D, Nordenstrom J. The design, fate and impact of a hospital-wide training program in evidence-based medicine for physicians - an observational study. BMC Med Educ. 2016;16(1):86.

Sonnadara RR, Van Vliet A, Safir O, Alman B, Ferguson P, Kraemer W, et al. Orthopedic boot camp: examining the effectiveness of an intensive surgical skills course. Surgery. 2011;149(6):745–9.

McCartney M, Treadwell J, Maskrey N, Lehman R. Making evidence based medicine work for individual patients. BMJ. 2016;353:i2452.

Simons M. Correction: What are the links between evidence-based medicine and shared decision-making in training programs for junior doctors? A scoping review protocol. BMJ Open. 2020;10(6):e037225corr1.

Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71–2.

Pan L. Medical Education - the tyranny of guidelines and the single best answer. 2019 [Available from: https://blogs.bmj.com/bmj/2019/10/01/liyang-pan-medical-education-the-tyranny-of-guidelines-and-the-single-best-answer/.

Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet. 2017;390(10092):415–23.

Barnhoorn PC, Houtlosser M, Ottenhoff-de Jonge MW, Essers G, Numans ME, Kramer AWM. A practical framework for remediating unprofessional behavior and for developing professionalism competencies and a professional identity. Med Teach. 2019;41(3):303–8.

Bateson G. The logical categories of learning and communcation (1972). The university of chicage press edition; 2000. p. 279–308.

Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015;90(6):718–25.

van den Broek S, Querido S, Wijnen-Meijer M, van Dijk M, Ten Cate O. Social Identification with the Medical Profession in the Transition from Student to Practitioner. Teach Learn Med. 2020.

Monrouxe LV, Rees CE. Theoretical perspectives on identity: researching identities in healtcare education. In: Cleland JD, editor. Researching Medical Education; 2015. p. 129–40.

Park YS, Konge L, Artino AR Jr. The Positivism Paradigm of Research. Acad Med. 2020;95(5):690–4.

Braschi E, Stacey D, Legare F, Grad R, Archibald D. Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis. Perspect Med Educ. 2020.

Maskrey N. Shared decision making: why the slow progress? An essay by Neal Maskrey. BMJ. 2019;367:l6762.

Greenhalgh T, Howick J, Maskrey N. Evidence Based Medicine Renaissance G. Evidence based medicine: a movement in crisis? BMJ. 2014;348:g3725.

Kunneman M, Henselmans I, Gartner FR, Bomhof-Roordink H, Pieterse AH. Do Shared Decision-Making Measures Reflect Key Elements of Shared Decision Making? A Content Review of Coding Schemes. Med Decis Making. 2019;39(7):886–93.

Butow P, Brown R, Aldridge J, Juraskova I, Zoller P, Boyle F, et al. Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect. 2015;18(6):2570–83.

Geiger F, Liethmann K, Reitz D, Galalae R, Kasper J. Efficacy of the doktormitSDM training module in supporting shared decision making - Results from a multicenter double-blind randomized controlled trial. Patient Educ Couns. 2017;100(12):2331–8.

Diouf NT, Menear M, Robitaille H, Painchaud Guerard G, Legare F. Training health professionals in shared decision making: update of an international environmental scan. Patient Educ Couns. 2016.

Rusiecki J, Schell J, Rothenberger S, Merriam S, McNeil M, Spagnoletti C. An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center. Acad Med. 2018;93(6):937–42.

Sanders AR, Bensing JM, Essed MA, Magnee T, de Wit NJ, Verhaak PF. Does training general practitioners result in more shared decision making during consultations? Patient Educ Couns. 2017;100(3):563–74.

Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med. 2012;87(9):1185–90.

Korthagen FAJ. In search of the essence of a good teacher: towards a more holistic approach in teacher education. Teach Teach Educ. 2004;20:77–97.

Passi V, Johnson N. The hidden process of positive doctor role modelling. Med Teach. 2016;38(7):700–7.