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首页> 外文期刊>Journal of human nutrition and dietetics >Patient perceptions of clinical decision making for percutaneous endoscopic gastrostomy placement.
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Patient perceptions of clinical decision making for percutaneous endoscopic gastrostomy placement.

机译：患者对经皮内镜下胃造口术放置的临床决策的看法。

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Background: Government health care policy encourages service providers to involve service users in decisions regarding their care. It is generally accepted that patients should be provided with sufficient and appropriate information to enable them to make informed decisions. The aim of this study was to explore patients' perceptions of the adequacy of the information provided and their subsequent involvement in the decision making process for percutaneous endoscopic gastrostomy (PEG) insertion. Methods: The study was a cross-sectional qualitative design using semi-structured interviews and purposive sampling to ensure the inclusion of adults with a range of diagnoses. The interviews were tape recorded and following each interview comprehensive field notes were made which described any significant events or emotions that had occurred during the interview. These included issues such as reflective thoughts and perceptions of the participants during the interview process. The interviews were then transcribed verbatim. Thematic analysis was selected for data analysis. The analysis followed three main processes; data reduction, data display and data complication (Miles & Huberman, 1994). Ethical approval was obtained from the local research ethics committee. Results: Sixteen patient interviews were undertaken. Eleven of the patients reported they had no involvement at all in the decision making process and ten of these perceived the information they had received prior to PEG insertion to be inadequate. Only four patients had found the information useful. The key theme that emerged from the data was 'exclusion' as patients explained how they felt they had no choice in the decisions taken, for example, 'I had no choice, the doctors made the decision'. Patients described how they found the attitudes of many healthcare professionals to be paternalistic and prescriptive in how they had made the recommendation for PEG placement. In addition, some patients described a total lack of information,'I received no information at all, everyone was so blase about it, except me' whilst others described being well informed of the procedure for the PEG placement but having no information regardingthe practicalities and organisation of feeding, especially the requirements ofthe feeding regimen,' I was told what it was for, but I only found out the important things much later, like how many hours every day I would spend feeding and how I would get the feed and giving sets'. Discussion: This qualitative study demonstrates a clear need to address the barriers to the provision of adequate and appropriate information to enable patients to make an informed decision. Improved communication is crucial to improve the patients perceived level of involvement in clinical decision making processes. Conclusions: The development of decision making models which support interdisciplinary and participative approaches to decision making are required. Reference Miles, M.B. & Huberman, A.M. (1994) Qualitative Data Analysis, 2nd edn. Thousand Oaks, CA: Sage Publications.
机译：背景：政府的医疗保健政策鼓励服务提供者让服务使用者参与有关其护理的决策。人们普遍认为应该为患者提供足够和适当的信息，以使他们能够做出明智的决定。这项研究的目的是探讨患者对所提供信息是否足够的认识，以及他们随后参与经皮内镜胃造口术（PEG）插入的决策过程。方法：本研究是横断面定性设计，使用半结构化访谈和有针对性的抽样检查，以确保纳入具有一系列诊断的成年人。对访谈进行录音，并在每次访谈之后进行全面的现场记录，以描述访谈期间发生的任何重大事件或情感。这些问题包括面试过程中参与者的反思性思想和看法。然后将访谈逐字记录下来。选择主题分析进行数据分析。分析遵循三个主要过程：数据减少，数据显示和数据复杂化（Miles＆Huberman，1994）。获得当地研究伦理委员会的伦理批准。结果：进行了十六次患者访谈。 11名患者报告说他们完全没有参与决策过程，其中10名患者认为在插入PEG之前收到的信息不足。只有四名患者发现该信息有用。数据中出现的关键主题是“排除”，因为患者解释了他们认为自己在做出的决定中别无选择，例如，“我别无选择，医生做出了决定”。患者描述了他们如何发现许多医护人员的态度是家长式的和处方性的，从而说明了他们对PEG放置的建议。此外，有些患者描述完全缺乏信息，“我什么都没收到，除了我之外，每个人都非常高兴”，而其他患者则描述了对PEG植入程序的充分了解，但没有关于实用性和实用性的信息。有人告诉我这是干什么的，但是我直到很晚才发现重要的事情，例如每天要花多少小时，如何获得和给予食物。集”。讨论：这项定性研究表明，显然需要解决提供足够和适当信息以使患者能够做出明智决定的障碍。改善沟通对于提高患者对临床决策过程的感知程度至关重要。结论：需要开发支持跨学科和参与性决策方法的决策模型。参考英里＆Huberman，A.M. （1994）定性数据分析，第二版。加利福尼亚州千橡市：Sage出版物。

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