消化科患者知情同意权实施的调查与研究

Gastroenterology informed consent of patients and the implementation of the survey

目的:了解消化科住院病人对病情渴望理解的程度、对知情同意权了解的程度及授权委托的情况,并分析授权委托的医嘱实施情况,以期分析知情同意权实施存在的问题,改善患者在就医过程中地位。方法:对2010年7月至9月消化科所有住院患者及家属采用自制问卷调查法进行调查,并将所有数据录入SPSS 17.0统计软件,分别进行统计描述、t检验、2χ检验。结果:87.5%的患者渴望了解病情,良恶性疾病患者无差异性;但仅9.2%的患者了解知情同意权的内容,年龄、居住地、学历不同的患者对知情同意权的了解存在统计学差异;住院病人中47.7%签授权委托书,授权委托书的签写率随年龄、学历、预后的不同,存在统计学差异;授权家属中42.17%的家属并未完全遵从医生的医嘱要求执行医嘱,授权组与未授权组病人医嘱执行存在统计学差异,授权委托病人疾病预后不同者医嘱执行情况有统计学差异。结论:患者对知情同意权的了解甚少,知情同意权的行使主体中接近一半为病人家属,但并不是所有家属都按最大有利于患者疾病治疗的诊治方案行使委托权,医疗工作者应在不伤害患者的前提下,尽量让患者本人行使知情同意权,以提高其在就医过程中的地位,保障患者利益。

Objective： To be aware of patient＇s desire of understanding the state of illness,the understanding of informed consent and the status of authorization level,and analyzing the implementation of authorized doctor＇s advice in order to analyze the problems in implementing informed consent,and to improve the patient＇s position in the process of medical treatment.Methods： Using self-made questionare to investigate all the hospitatalized patients of digestive department and their families from July to September of 2010.All the data were logged into SPSS 17.0 to do statistical description,t-test and χ2 test were used to analyze those data.Results： 87.5% patients eager to understand the state of illness,regardless of benign and malignant patient;but only 9.2% patients know informed consent,the understanding of informed consent have significant difference according to different age,residence,education;47.7% signed letter of authorization,it also have significant differences according to different age,education and prognosis.42.17% of the authorized family members did not fully comply with requirements to perform the clinical doctor＇s medical advice,the performance of doctor＇s orders have significant difference between authorized and unauthorized patients,and the execution of doctor＇s advice of authorized also have significant difference in disease prognosis.Conclusion： Patients know little things about informed consent rights,and almost half of the exercising main body are family members of the patients.Not all of the family members exercise the attorney rights according to the maximum benificial treatment scheme to the patients.Therefore medical practitioners should try to enable patients to exercise the informed consent,to improve their medical status of the process and protect their interests.