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951.
在医患关系中,患者亲属起着重要作用,是医疗行为及后果生理和心理的承担者,患者的疾病本身和康复情况会直接对家庭生活产生影响。患者亲属也是患者医疗费用的主要承担者。由于医疗决策会涉及到患者的家庭利益,患者患病会对其决定能力产生不利的影响,在法律上确立患者亲属在医患关系中的主体地位,甚至在必要时赋予亲属医疗决定权是必要的和现实的。 相似文献
952.
汪能平 《医学与哲学(人文社会医学版)》2007,28(4):5-6,24
就常见的临床诊疗决策失误,从四个方面探讨失误的原因。首先是对患者的发病过程的相关情况掌握不全面、不准确:其次是对患者的化验与检查结果用于诊断与治疗不尽合理:第三是未处理好对患者的诊断与治疗之间的相互关系:第四是未处理好如何发挥各级各类专家的智慧、学识与经验,用于整个临床诊断与治疗的决策过程。总而言之,影响临床决策的环节多,且贯穿于整个临床过程,医师们应重视循证医学证据,始终都要把握好,不可稍有粗疏,否则将不利于提升医疗质量,难以确保医疗安全。 相似文献
953.
越是给熟人、领导、要人做手术,出现各种手术相关问题的几率就越高。其原因主要是医生受各种情感因素的影响,降低了对医疗核心制度的执行标准,简化了术前准备,放宽了手术适应证,非理性地扩大了手术范围。解决方法:对待任何病人首先必须恪守法律和医疗规范,在此基础上尽可能与病人进行情感交流,达到医患共同自觉执行相关法律和规章,降低情感因素对手术决策的负性作用。 相似文献
954.
职业精神和医患关系 总被引:5,自引:1,他引:4
Wendy Levinson 《医学与哲学(人文社会医学版)》2007,28(3):18-18,77
通过调查发现,外科医生在提供做决策的信息的问题上执行得较好;有些医生无论错误多么严重也不会把医疗错误披露出来;但是能够公开医生的经济奖励,这样医生的信任不但没有被损害,相反医生和医生团体的信任和忠诚却增强了。从知情决策、医疗错误的披露和利益冲突三个方面展示职业精神对医患关系产生的影响,并为职业精神的发展提供了新视角。 相似文献
955.
956.
This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects. 相似文献
957.
Kelly KM Shedlosky-Shoemaker R Porter K Remy A DeSimone P Andrykowski MA 《Journal of genetic counseling》2007,16(3):373-382
Family history is one the greatest risk factors for disease and one of the most important informational tools in medical genetics
for the purpose of diagnosis, risk assessment, prevention and treatment. However, research is needed on the comparability
of different methods of cancer family history assessment and the influence of psychosocial factors in family history reports.
The purpose of this study was to determine if individuals had discrepancies between written and interview reports of cancer
family history and the role of psychosocial factors in these discrepancies. Oncology patients (n=104) were administered a survey to assess psychosocial factors (i.e., information-seeking, worry, perceived risk, and health
literacy) and were asked to provide family history in a written and an interview form. Randomization determined which form
individuals received first. No differences in the amount of missing data or the amount of unspecified data were noted between
the written and interview method. Psychosocial factors did not differentiate between those who had discrepancies in family
history reports and those who did not have discrepancies in family history reports; although there was a trend for those with
lower literacy and those who were blunters to be more discrepant on type of cancer diagnosis. In sum, this preliminary study
indicates that written and interview methods of family history assessment for first degree relatives may be used interchangeably.
The ability to use written methods will facilitate collection of basic family history information in the oncology clinic. 相似文献
958.
This study examined women’s recall of physician recommendations as well as patient satisfaction following participation in
a breast/ovarian cancer risk and prevention program. Participants were 41 high risk women who attended a cancer risk program
4–6 months earlier. Two-thirds of women who received recommendations for tamoxifen treatment and genetic testing did not recall
these recommendations upon follow-up. A number of women misunderstood recommendations and a quarter of the sample recalled
recommendations that were not made during the consultation. Although these high risk women were generally satisfied with their
counseling visit, those individuals who received particularly complex sets of recommendations reported feeling less understood
and were less satisfied with the counseling. Findings underline the importance of examining recommendation recall, in addition
to perceptions of cancer risk, when evaluating the clinical implications of cancer risk assessment. 相似文献
959.
Rarely has utilization of genetic counseling for Hereditary Breast and Ovarian Cancer (HBOC) been studied separately from
utilization of testing. At Kaiser Permanente Colorado, consistently only 30% of all members referred for HBOC attend genetic
counseling. To increase the volume of genetic counseling appointments, a patient navigator approach was pilot tested in a
randomized-controlled trial over 3 months. A total of 125 members were referred for HBOC genetic counseling (55 randomized
to PN, 70 randomized to usual care). Utilization of referrals for Navigator-assisted members was 44%, compared to 31% in the
usual care arm (p=0.16). The patient navigator significantly decreased time to appointment, with over 80% of Navigator-assisted members seen
for genetic counseling less than three months from referral date, compared to 32% in usual care (p=0.002). patient navigator assistance shortens time from referral to appointment for HBOC genetic counseling, and may increase
utilization of such services. 相似文献
960.
A genetic counselor is often faced with the difficult task of conveying a set of complex and highly abstract factors associated
with the client's risk of developing a familial disorder. The client is faced with the even more difficult task of making
significant health-related decisions about an event which may or may not eventuate. Although there is a large corpus of research
on this topic, much of the knowledge on risk communication is difficult to apply in a practical context. In this paper we
draw together some insights on risk communication and decision-making under conditions of uncertainty, and apply them directly
to the problem of communicating familial cancer risk. In particular, we focus on the distinction between individual risk and
observed frequencies of adverse events, various framing effects, and contextualizing risk communication. We draw attention
to some of the potential pitfalls in counseling about risk and offer avenues for circumventing them. 相似文献