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In order to further understand the cognitive attitude of different groups towards the rank of rights and interests in medical decision-making and its influencing factors, and provide theoretical reference for the practice of medical decision-making, this study conducted convenience sampling through the questionnaire star enterprise edition. The collected data were descriptive statistical analysis with SPSS 21.0 software and joint hypothesis testing. The results showed that there were differences in the cognition of religious beliefs on the same individual’s rights and interests rank among the sample population (P<0.05). There were differences in the cognition of professional title, working years and institution level on the attitude of rights and interests rank in the group of medical institutions (P<0.05). In the ranking of the importance of individual rights usually involved in medical activities, the rights to life, health and equality were the most important. Most people can rationally view the rights and interests of doctors, patients and stakeholders. In medical decision-making, we should adhere to the principle of right rank, give priority to safeguarding the right to life and give consideration to fairness and justice. In the face of conflicts of interest, we should do a good job in value evaluation, safeguard the reasonable interests of patients and give consideration to the demands of family members.
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Whether children can exercise their medical decision-making power has always been a controversial topic in law and ethics, and it is also the focus of attention of people from all walks of life. In this regard, combined with the problems existing in the exercise of children’s medical decision-making power, such as conflict with the right to life and health, insufficient guarantee of the right to informed consent system, and the legal guardian’s exercise of children’s medical decision-making power may not be in the best interests of children. This paper discussed the dilemma and feasibility of children’s exercise of medical decision-making power from three aspects: children’s right to life and health, the evaluation of informed consent and medical decision-making ability, and the thinking of children’s informed consent and medical decision-making ability, and pointed out that children who are able to make self-determination should be fully endowed with legal medical decision-making power, so as to ensure their best interests in medical clinic.
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In recent years, the issue of end-of-life decision making has received broad attention. More and more people have been appealing for the respect for terminal patients’ wishes in decision making. Many scholars have proposed the application of advance medical decision to ensure the autonomy of terminally ill patients. Given that advance medical decision does not have legal effect in China, the Beijing Health Law Society proposed the "Expert Consensus on Legal Issues Related to End-of-life Decision Making" in July 2022. This consensus provides clear guidance on how to make medical decisions for terminally ill patients, based on the principle of respecting the patient’s wishes within the framework of current laws and regulations. The consensus aims to provide guidance for both doctors and patients about how to respect patients’ own wishes and protect their autonomy, as well as to provide reference for future law and policy formulation on related issues.
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Taking nephrotic syndrome as an example, this paper analyzed the autonomy of patients with chronic diseases in medical decision-making, and recognized that patients have autonomy in five dimensions: information, expression, function, decision-making and implementation. Respecting patient autonomy can enable patients to make decisions in their best interests, which is the basis for relevant medical decision-making. However, respecting patient autonomy in medical decision-making of chronic diseases also faces some problems such as limited autonomy of some patients with chronic diseases, poor communication of medical information or lack of resources weakens the autonomy of medical decision-making of patients with chronic diseases, and the difference in health literacy and health management ability affects the play of patient autonomy. Taking the patients with nephrotic syndrome as an example, this paper proposed to recognize the limitations of the autonomy of patients with chronic diseases and flexibly use different ways to respect the autonomy of patients; improve the communication ability and joint decision-making experience of clinical medical staff to fully respect patients’ autonomy; enhance patients’ health literacy and health management ability to realize clinical practice strategy of respect for patients’ autonomy.
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In order to understand the actual needs and influencing factors of cancer patients to participate in medical decision-making, 29 cancer patients were selected for semi-structured interviews by purpose sampling from September 2020 to February 2021, and the data were analyzed by substantive coding step by step according to interview method. The results showed that the quality of patient-clinician interaction was an important factor influencing the decision quality. The elements for cancer patients to participate in medical decision-making include: patients’ disease knowledge, awareness of choice, communication duration, support from family members and doctors, and mutual trust between doctors and patients. Medical staff should respect patients’ preference to participate in medical decision-making, break the medical-centered system arrangement, help patients obtain services matching their preferences for participating in decision-making, and achieve a pattern that is beneficial to both patients and the medical system.
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"Qiong Yao incident" has triggered a discussion on the life-or-death choice in critically ill patients.Aimed at this problem,this paper analyzed the decision-making short cut of Confucian familism in Confucian life ethics,from the perspective of the implication of Confucian familism in medical ethics,the family consultation principle in medical decision making,the great significance of family-oriented medical decisions for patients and family members,and the family love in hospice care.In addition,it pointed out that hospice care in China is still in the preliminary exploration stage,so we should actively establish a road of hospice care which is suitable for China's national conditions.
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Through reviewing the concept, work content and standard work process of anesthesia clinic, this article analyzed the moral value of anesthesia clinic:beneficial to use the medical resources rationally, to improve patient safety, to enhance humanistic care, and to reflect the value of the anesthesia doctor. Then, it discussed the realization way of anesthesia clinic and aimed to improve the safety of operation and anesthesia, at the same time, to enhance the humanistic care of patients.
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Clinical reasoning is a core competency expected to be acquired by all clinicians. It is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process used to arrive at a diagnosis. Problems with clinical reasoning often occur because of inadequate knowledge, flaws in data gathering and improper approach to information processing. Some of the educational strategies which can be used to encourage acquisition of clinical reasoning skills are: exposure to a wide variety of clinical cases, activation of previous knowledge, development of illness scripts, sharing expert strategies to arrive at a diagnosis, forcing students to prioritize differential diagnoses; and encouraging reflection, metacognition, deliberate practice and availability of formative feedback. Assessment of clinical reasoning abilities should be done throughout the training course in diverse settings. Use of scenario based multiple choice questions, key feature test and script concordance test are some ways of theoretically assessing clinical reasoning ability. In the clinical setting, these skills can be tested in most forms of workplace based assessment. We recommend that clinical reasoning must be taught at all levels of medical training as it improves clinician performance and reduces cognitive errors.
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A la hora de realizar juicios y tomar decisiones sobre la salud, debemos procesar y comprender información numérica. Por ejemplo, habitualmente recibimos información sobre el riesgo de padecer una enfermedad en probabilidades, porcentajes o fracciones. Sin embargo, muchas personas presentan deficiencias a la hora de comprender esta información. En este trabajo, presentamos una revisión crítica de la evidencia empírica sobre los efectos que tienen las habilidades numéricas en diversos aspectos del proceso que acontece cuando un paciente acude al médico, más concretamente en la percepción de los riesgos médicos y la eficacia de los tratamientos. También describimos los distintos marcos teóricos que pretenden explicar estos efectos y resaltamos algunas de sus limitaciones. Por último, discutimos las ventajas y los inconvenientes de los instrumentos de medida de las habilidades numéricas, y destacamos entre ellos el Berlin Numeracy Test. Concluimos que este test puede evaluar las habilidades numéricas satisfactoriamente en diversos contextos, y planteamos diversas cuestiones que permanecen abiertas, como la relación entre las habilidades numéricas y diversos constructos psicológicos como la inteligencia o la reflexión cognitiva.
When we make judgments and decisions about our health, we are frequently faced with numerical information. For example, we often receive information concerning the risk of suffering an illness in terms of probabilities, percentages or fractions. However, many people have difficulties in understanding this type of information. In this paper, we present a critical review of the existing empirical evidence that documents the influence of numeracy on various aspects of the process that occurs when patients visit their doctor, focusing on perceptions of medical risks and treatment efficacy. We also outline different theoretical frameworks that have attempted to explain the impact of numeracy, highlighting some of their limitations. Finally, we discuss the advantages and disadvantages of existing tools for measuring numeracy, drawing attention to the Berlin Numeracy Test. We concluded that this test can satisfactorily assess numeracy in a wide range of contexts. We also discuss a number of open questions, including the relationship between numeracy and other psychological constructs, such as intelligence or cognitive reflection.
Subject(s)
Risk , Decision Making , Evaluation Studies as Topic , IndividualityABSTRACT
PURPOSE: To identify the recognition of patients, families, nurses, and physicians about clinical decision-making and biomedical ethics. METHODS: Data were collected from October 23 to 30, 2012 using the structured questionnaires. A total of 200 data were analyzed using SPSS 20.0 version. RESULTS: Response about 'who should receive the first notice of a cancer diagnosis?' was significant difference statistically. Cancer patients had preferences to be notified their diagnosis first. Patients responded the person who made decision of treatment options would be physician first and then themselves. Families, nurses, and physicians answered that decision-maker would be both of patient and family. All four groups answered that the person who made decision about care-giver after discharge was patient and their family. Nurses and physicians who didn't aware of the advanced directive were over 30.0%, and patients and family who didn't aware of that were over 60.0%. Lastly, the rate of positive answer about making attempt of advanced directive after legalization was over 80.0%. CONCLUSION: Patient's attitude about making decisions is different from family's attitude. Nurses and physicians have to put emphasis on the patient's autonomy & self-determination and family members' needs.
Subject(s)
Humans , Bioethics , Diagnosis , Surveys and QuestionnairesABSTRACT
OBJECTIVES: This study demonstrates the feasibility of using a modified mixture of experts (ME) model with repeated measured tumoural Ktrans value to perform an automatic diagnosis of responder based on perfusion magnetic resonance imaging (MRI) of rectal cancer. METHODS: The data used in this study was obtained from 39 patients with primary rectal carcinoma who were scheduled for preoperative chemoradiotherapy. The modified ME model is a joint modeling of the ME model via the linear mixed effect model. First, we considered two local experts and a gating network, and the modified expert network as a liner mixed effect model. Afterward, the finding estimates were obtained via the expectation-maximization algorithm. All computation was performed by R-2.15.2. RESULTS: We found that two experts have different patterns. The feature of expert 1 (n = 10) had a higher baseline value and a lower slope than expert 2 (n = 29). A comparison of the estimated experts and responder/non-responder groups according to T-downstaging criteria showed that expert 1 had a more effect treatment responder than expert 2. CONCLUSIONS: A novel feature of this study is that it is an extension of classical ME models in case of repeatedly measured data. The proposed model has the advantages of flexibility and adaptability for identifying distinct subgroups with various time patterns, and it can be applied to biomedical data which is measured repeatedly, such as time-course microarray data or cohort data. This method can assist physicians as important diagnostic decision making mechanism.