(informed consent) 6
. (Informed 23 Consent) 24 (Informed Consent) informed consent 1. 2. 7
3. 4. 5. 6.. 26 1. 8
2. 3. 4. 5. 6.. Braddock 1993 59 65 1057 (discussion of the patient s role in decision making) (discussion of the clinical issue or nature of the decision) discussion of the alternatives 9
(discussion of the pros/potential benefits and cons/risk of the alternatives) (discussion of uncertainties associated with the decision) (assessment of the patient s understanding) exploration of patient preference 27. 1989 847 95% 90% 28 80% Coulter 28 62 Understand what is wrong Gain a realistic idea of prognosis Make the most of consultations Understand the processes and likely outcomes of possible tests and treatments Assist in self care 10
Learn about available services and sources of help Provide reassurance and help to cope Help others understand Legitimise seeking help and their concerns Learn how to prevent further illness Identify further information and self help groups Identify the best healthcare providers 29 84 12 21 Likert s 5 1-5 21 11
30 31 32 What is causing the problem?? Am I alone? How does my experience compare with that of other patients?? Is there anything I can do myself to ameliorate the problem? What is the purpose of the tests and investigations? What are the different treatment options? What are the 12
benefits of the treatment(s)? What are the risks of the treatment(s)?? Is it essential to have treatment for this problem? Will the treatment(s) relieve the symptoms? How long will it take to recover? What are the possible side effects? What will the treatment(s) have on my feelings and emotions? What effect will the treatment(s) have on my sex life? How will it affect my risk of disease in the future? How can I prepare myself for the treatment? What procedures will be followed if I go to hospital? When can I go home? What do my careers need to know? What can I do to speed recovery? What are the options for rehabilitation? How can I prevent recurrence or future illness? Where can I get more information about the problem or treatments? 33 13
(what is the cause of symptom x?) (what is the dose of drug x) (how should I manage disease or finding x) (how should I treat finding or disease x) (what is the cause of physical finding x) (what is the cause of test finding x) (could this patient have disease or condition x) (is test x indicated in situation y) (what is the drug of choice for condition x) (is drug x indicated in situation y) 56% 34 1. (1) 14
(2) (3) (4) (5) (6) (7) 2. 3. 15
4. 5. 6. 7. 8.. 35 88 434 16
50% 40% 36 88.9% 72.2% 51.7% 32.6% 4.2% 37 17
2-1-1 18
2-1-1 medical information 1 1. ( 2. 3. ) 4. 5. 6. 7. 2 1. 2. 3. 4. 3 1. 2. 4 1. 2. 5 1. 2. 3. 6 7 19