Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians.

Davies M; Elwyn G; Papadopoulos I; Fleming L; Williams G

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Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians.

机译：促进患者决策可以排他吗？英国产妇临床医生的叙述中的道德期望和文化差异。

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Patient autonomy in health care decision making is increasingly advocated as a means of promoting patients' 'responsibilities' for treatments and costs. However, little is known with regard to clinicians' understanding of patients' potential responsibilities in decision making. We explore how clinicians may view decision making as a 'moral' obligation and examine how moral virtue is discursively constructed in this context and in the face of ethnic and social difference. Data reported are derived from an interview study that examined perceptions of maternity decision making among Arab Muslim women and clinicians. Results reported here are from the clinician sample which includes obstetricians, general practitioners (GPs) and midwives. Clinicians perceived that a key element of their role involved imparting relevant information to their clients and, increasingly, involving them in making autonomous decisions about their care. However, by analysing and assessing the attribution of specific cultural differences in clinicians' discussion of decision making processes with minority group women, we demonstrate how some clinicians justified their failure to promote autonomy through shared decision making with women from these groups. We will demonstrate these attributes to be those of passivity and non-rationality which entail some negative moral judgements and which have a complex relationship to gender and power

机译：越来越多地提倡患者在医疗保健决策中的自主权，以此来提升患者对治疗和费用的“责任”。然而，关于临床医生对患者在决策中潜在责任的理解知之甚少。我们探讨了临床医生如何将决策视为一种“道德”义务，并研究了在这种情况下以及面对种族和社会差异时如何以道德方式建构道德美德。报告的数据来自一项访谈研究，该研究调查了阿拉伯穆斯林妇女和临床医生对产妇决策的看法。此处报告的结果来自临床样本，包括产科医生，全科医生（GPs）和助产士。临床医生认为，其角色的关键要素包括向其客户提供相关信息，并越来越多地使他们参与有关其护理的自主决策。但是，通过分析和评估临床医生在与少数群体妇女的决策过程讨论中特定文化差异的归因，我们证明了一些临床医生如何通过与这些群体的妇女共同决策来证明自己未能促进自治的理由。我们将证明这些属性是消极和非理性的属性，这些属性包含一些负面的道德判断，并且与性别和权力有着复杂的关系

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《Communication & medicine》 |2009年第1期|共10页
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Davies M; Elwyn G; Papadopoulos I; Fleming L; Williams G;
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中图分类预防医学、卫生学;
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1. Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians. [J] . Davies M, Elwyn G, Papadopoulos I, Communication & medicine . 2009,第1期

机译：促进患者决策可以排他吗？英国产妇临床医生的叙述中的道德期望和文化差异。
2. Interventions that improve maternity care for immigrant women in the UK: protocol for a narrative synthesis systematic review,Correction: Interventions that improve maternity care for immigrant women in the UK: protocol for a narrative synthesis systemati [J] . Jeanette Eldridge, Catrin Evans, Gina Marie Awoko Higginbottom, BMJ Open . 2017,第7期

机译：改善英国移民妇女产妇保健的干预措施：叙事综合系统评价的方案，修正：改善英国移民妇女产妇保健的干预措施：叙事综合系统的方案
3. Correction: Interventions that improve maternity care for immigrant women in the UK: protocol for a narrative synthesis systematic review,Interventions that improve maternity care for immigrant women in the UK: protocol for a narrative synthesis systemati [J] . BMJ Open . 2017,第9期

机译：更正：改善英国移民妇女产妇保健的干预措施：叙事综合系统评价的规程;改善英国移民妇女产妇保健的干预措施：叙事综合系统的规程
4. Promoting Patient Voices on the Internet: Ethical considerations about web-based dissemination of research on patient narratives [C] . Marianne V. Trondsen, Line Lundvoll Warth, Kari Dyb, International Conference on eHealth, Telemedicine, and Social Medicine . 2016

机译：促进互联网上的患者声音：关于患者叙事研究的基于网络传播的道德考虑因素
5. Education of the rabbinical and genetic counseling communities to promote culturally sensitive genetic testing decisions for the Orthodox Jewish patient. [D] . Haskins, Rebecca. 2010

机译：对阿拉伯和遗传咨询社区进行教育，以促进对东正教犹太人患者进行文化敏感的基因检测决策。
6. What do patients want from their GP? Common expectations beyond cultural differences. [O] . M D Beaulieu 2000

机译：患者想从全科医生那里得到什么？超越文化差异的共同期望。
7. Decision-making is the process of analyzing information about a problem situation and comparing it to a specific conclusion in order to solve a specific problematic (Yıkılmaz, 2001; Miller and Byrnes, 2001). Decision-making styles are a mechanism that is influenced by the internal and external conditions that determine the direction of the decisions of the individual, the content of the decision-making process, and the outcome of the decision-making process (Payne, Bettman and Johson, 1993; Bavol’ár and Orosová, 2015). ACT is a contemporary member of the Cognitive Behavioral Therapy family. ACT (Acceptance and commitment therapy) has both similar and different directions with Behavioral Therapies and Cognitive Therapies (Herbet and Forman, 2011; Hayes, 2004). KKT responds to classical behavioral treatments using both existential and cognitive approaches in the analysis of behavior. KKT is a science wing that tries to solve human problems with a wider perspective aimed at solving problematic human behaviors (Plumb, Stewart, Dahl and Lundgren, 2009). It is seen that there is very little research about the new approach of ACT approach when the aiming country of our country is screened and it is thought that our country will contribute to the field of psychological counseling with the work done. In the scope of the research, experimental and control groups and preliminary test, post-test and follow-up measurements of 2x3 experimental design were used. The study's study group consists of a total of 24 (12 experimental and 12 control groups) university students studying in different departments and levels, continuing their education in the academic year of 2015-2016 in Ağrı province and İbrahim Chechen University in 2015-2016 academic year. The average age of participants in the experiment and control group is 20. There were 12 participants in the experimental group, 7 female and 5 male, and 12 participants, 7 female and 5 male in the control group. Personal Information Form and Decision Making Style Scale prepared by the researcher were used in the research. In order to decide on the tests to be used in the course of analyzing the data, the scores of the participant's Decision Styles Scale pre-test, which are placed primarily in the experimental and control groups, it was analyzed whether the basic expectations of parametric tests were answered. As a result of the analysis made, the scores, skewness and kurtosis coefficients obtained from the Decision Making Styles Scale were given to the experimental and control groups. It was determined that the distribution was normal in the result of Shapiro-Wilk test, in which the skewness and kurtosis coefficients of each sub-scale were ranked between -1 and +1. Participants in the experimental and control groups; homogeneity test results for decision-style pre-test measurements indicate that the data are homogeneous. According to the results of the Mauchly Globalness Test, it has been determined that working supports the hypothesis. It was determined that there was no significant difference between the pre-test scores obtained from dependent decision-making style of experiment and control groups, but the test group showed lower mean scores at the significant level within the scores of post-test and follow-up tests. Therefore, it can be said that the ACT-oriented psychoeducation program applied to the experimental group reduces the dependent decision-making style scores from the decision style sub-dimensions and the psychoeducation program has a lasting effect. It was determined that there was no significant difference between pre-test, post-test and follow-up scores obtained from the Spontaneous-Instant Decision Style of experiment and control groups. Thus, it can be said that this situation does not cause a significant difference in the Spontaneous-Decision-Making Style scores from the decision style sub-dimensions of the ACT-oriented psychoeducation program applied to the experimental group. The ACT -oriented psychoeducation program had a decline in the intuitive decision-making styles of the individuals, but this decrease did not create significant differences. Thus, it can be said that this situation does not make a meaningful difference in the intuitive decision style scores from the decision style sub-dimensions of the KKT oriented psychoeducation program applied to the experimental group. The pre-test scores obtained from the rational decision-making style of the experimental and control groups showed that there was a difference between the post-test and the follow-up scores, but this difference was not significant. As a result of the analysis, it was determined that the test group had higher levels of rational decision style than the pre - test scores in the post test and follow - up scores, whereas the post test and follow - up test scores in the control group rational decision style showed a decrease compared to the pre - test scores. the pre - test scores. Decision-making Styles Scale Avoidant Decision Making As a result of the analysis of the mean scores of the subscale scores of pre-test, post-test and follow-up measures, the group effect was found to be insignificant. It was determined that the experimental and control groups differed significantly from the pre-test scores obtained from the avoidant decision-making style but did not show any significant change within the scores of the post-test and follow-up tests. [O] . mustafa ercengiz, ali haydar şar 2018

机译：决策是分析有关问题情况的信息并将其与特定结论进行比较的过程，以解决特定的问题（Yıkılmaz，2001; Miller和Byrnes，2001）。决策风格是一种机制，受到内部和外部条件的影响，确定个人决定的方向，决策过程的内容以及决策过程的结果（PAYNE，BETTMAN和BEDNE） Johson，1993;Bavol'ár和奥萨洛瓦，2015）。法案是认知行为治疗家庭的当代成员。行为（验收和承诺治疗）具有与行为疗法和认知疗法的类似和不同方向（Herbet和Forman，2011; Hayes，2004）。 KKT在分析行为中使用存在性和认知方法来响应古典行为治疗方法。 KKT是一个科学翼，试图解决人类问题，旨在解决有问题的人类行为（铅垂，斯图尔特，Dahl和Lundgren，2009）。有人认为，当我们国家的瞄准国家进行筛选时，有关行动方法的新方法几乎没有研究，并且认为我们的国家将为完成工作做出贡献的心理咨询领域。在研究的范围内，使用实验和对照组和初步测试，使用后测试和后续测量的2x3实验设计。该研究的研究小组包括共24名（12个实验和12个对照组）大学学生在不同的部门和水平上学习，在2015-2016学术上继续进行2015-2016的学术年度2015-2016学年年。实验和对照组参与者的平均年龄是20.实验组中有12名参与者，7名女性和5名男性，12名参与者，7名女性和5名男性。研究人员准备的个人信息表格和决策制定风格规模在研究中使用。为了决定在分析数据的过程中使用的测试，参与者的决策风格刻度预测的分数主要在实验和对照组中进行，分析了参数的基本期望吗？测试得到了回答。由于对实验和对照组给出了从决策曲调标度获得的分数，偏移和峰度分子系数。确定该分布是正常的在成熟的-WILK试验结果中，其中每亚级的偏差和刚度系数在-1到+1之间排名。实验和对照组的参与者;决策式预测测量的同质性测试结果表明数据是均匀的。根据毛毛环保试验的结果，已确定工作支持假设。据确定，从依赖决策风格的实验和对照组获得的预测分数之间没有显着差异，但测试组在测试后的分数内显示出较低的平均分数和后续的分数 - 测试。因此，可以说，应用于实验组的面向活动的心理教育程序减少了决策风格子维度的依赖决策风格分数，并且心理教育程序具有持久的效果。据确定，从实验和对照组自发决策风格获得的预测试，测试后和后续评分之间没有显着差异。因此，可以说这种情况不会导致从应用于实验组的活动导向的心理教育程序的决策风格分数的自发决策风格分数显着差异。行为的心理教育计划在个人直观的决策风格下降，但这种减少并没有产生显着的差异。因此，可以说，这种情况不会在从应用于实验组的KKT导向的心理教育程序的决策风格分数中产生有意义的决策风格分数。从实验和对照组的理性决策风格获得的预测分数显示后检验后和随访评分之间存在差异，但这种差异并不重要。由于分析，确定测试组的理性决策风格较高，而不是后测试和后续分数的预测分数，而对照组合理决策风格的后测试和后续测试分数显示出与预测试分数相比的减少。预测分数。决策款式扩展避免决策由于分析了预测试，测试后和后续措施的班次评分的平均分数，发现群体效应是微不足道的。确定实验和对照组从避免决策风格获得的预测评分中显着不同，但在测试后和后续测试的分数内没有显示出任何重大变化。
8. Acculturation Indices as a Means of Confirming Cultural Differences. Navy Recruit's Expectations of Productivity, Liking, and Intentions to Quit under Different Supervisors [R] . Triandis, H. C., Kashima, Y., Shimada, E., 1983

机译：文化适应指数作为确认文化差异的手段。海军新兵对不同监督下的生产力，喜好和意愿的期望

Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians.

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