摘要
为了探讨直肠癌行肠造口患者关于治疗方案共享决策的现状,了解患者被告知或隐瞒手术方案的真实感受,为制定更有利于患者的共享决策方案提供依据。采用现象学方法,对在西安市某医院因直肠癌行过肠造口术后的12名患者进行半结构化访谈,对访谈数据进行资料分析,提炼主题。共提炼出负性情绪、病情告知不足、造口自我接纳和护理三个主题。发现家属替代式决策模式在直肠癌肠造口患者临床治疗方案确定中占据主导地位,病情告知不足影响了患者对造口的适应与接受,引发负性心理反应。建议医务人员应个体化、客观评价患者参与治疗决策,恰当运用沟通技巧告知病情,在不伤害的原则下尊重患者自主权利,真正维护患者权益。
The purpose of this study is to explore the current situation of the sharing decision-making of treatment plan for the rectal cancer patients undergoing enterostomy,to understand the real experience of patients who are informed or concealed about the operation plan,so as to provide a basis for making a more favorable sharing decision plan for patients.In this study,the phenomenological method was used to conduct semi-structured interviews with 12 patients who had undergone enterostomy for rectal cancer in a hospital in Xi’an city.The interview data were analyzed and the theme was extracted.Three themes were extracted:negative emotion,insufficient information about the disease,self-acceptance of enterostomy and nursing.It was found that the family substitution decision-making model was the dominant position in the determination of the clinical treatment plan of rectal cancer patients with enterostomy.Insufficient information would affect patients’adaptation and acceptance of enterostomy,and lead to negative psychological reaction.Therefore,it is suggested that medical staff should evaluate patients’participation in treatment decision-making individually and objectively,properly use communication skills to inform patients of the disease,respect patients’independent rights under the principle of nonmaleficence and truly safeguard patients’rights and interests.
作者
郭媛
温绣蔺
辛霞
乔莉娜
金鲜珍
屈展
李晨陆
周光霞
丁雪梅
樊慧
GUO Yuan;WEN Xiulin;XIN Xia;QIAO Lina;JIN Xianzhen;QU Zhan;LI Chenlu;ZHOU Guangxia;DING Xuemei;FAN Hui(Department of Aesthetic Plastic&Maxillofacial Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Nursing Department,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;General Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Xi’an Jiaotong University Health Science Center,Xi’an 710061,China)
出处
《中国医学伦理学》
2020年第1期80-84,91,共6页
Chinese Medical Ethics
基金
陕西省科学技术攻关项目“陕西省造口病人同质化护理协作网构建及运行效果评价”(2019SF-124)
西安交通大学第一附属医院新医疗新技术“肠造口患者信息化技术管理模块的应用”(XJYFY-2016h5)
西安交通大学第一附属医院科研基金“标准化护理方案对永久性肠造口患者健康相关生活质量干预效果及机制研究”(2016HL-01)
关键词
直肠癌
肠造口
共享决策
真实体验
医患沟通
不伤害
Rectal Cancer
Enterostomy
Shared Decision-making
Real Experience
Doctor-patient Communication
Nonmaleficence