普外科高危手术医患共同决策面临的困境及对策

The dilemma and countermeasures faced by doctor-patient joint decision-making in high-risk procedures in general surgery

普外科高危手术通常风险高、不确定性大,患者可能面临生活和健康状况的重大改变,容易引发医患纠纷。总结普外科高危手术医患共同决策实施的障碍,探索将共同决策纳入临床实践的最佳方式。在决策过程中,存在普外科医生和患者需要共同克服沟通与决策能力欠缺、知情同意与认知能力不足、体制与文化问题等伦理困境。为帮助患者选择最适合的治疗方法,真实作出关于高危手术的决定,建议应加强普外科医生沟通技能培训,开发、运用决策辅助工具,同时多方支撑,为普外科医患共同决策的实施提供良好的环境。

High-risk procedures in general surgery usually carry high risks and uncertainties,and patients may face significant changes in their living and health conditions,which can easily lead to doctor-patient disputes.This paper summarized the obstacles to implementing joint decision-making of doctors and patients in high-risk procedures in general surgery,as well as explored the best way to incorporate joint decision-making into clinical practice.In the decision-making process,general surgeons and patients need to work together to overcome ethical dilemmas such as lack of communication and decision-making abilities,inadequate informed consent and cognitive abilities,as well as institutional and cultural issues.To help patients choose the most suitable treatment method and truly make decisions about high-risk procedures,it is recommended that China strengthen communication skills training for general surgeons,develop and utilize decision-making support tools,and simultaneously supported multiple parties,to provide a good incubation soil for the implementation of joint decision-making of doctors and patients in general surgery.