在治疗性内窥镜检查中实现真正个性化知情同意的挑战

IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY
Philip Berry, Sreelakshmi Kotha
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引用次数: 0

摘要

根据纳丁·蒙哥马利(Nadine Montgomery)的产科病例,并根据最新的总医学委员会指南,联合王国修订了关于内窥镜检查知情同意的指南。所有可能对患者产生重大影响的风险,以及手术的替代方案,都必须加以探讨。尽管如此,各部门和内窥镜医师仍在努力达到目前的标准。在这篇文章中,我们探讨了通过现实生活场景在治疗性内窥镜检查中实现个性化同意所遇到的挑战。方法介绍五种现实的肝胆内镜治疗方案,然后介绍可能的或理想的方法,并参考该领域的现有文献。结果这些小片段考虑了如何处理困难的同意挑战,包括焦虑和信息过载、急性病期间的紧迫性、未能披露死亡风险、受训者的作用和有意识镇静下的术中窘迫。作者得出结论,在获得治疗性内窥镜检查的同意时,需要高度的透明度,并伴有完整的文件,几乎所有病例都有亲属参与,以及可能处理内窥镜的受训者在场的透明度。需要更加注重在治疗性内窥镜检查的同意过程中提高受训者的技能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Challenge of achieving truly individualised informed consent in therapeutic endoscopy
Objective Guidance covering informed consent in endoscopy has been refined in the UK following the obstetric case of Nadine Montgomery, and in light of updated General Medical Council guidance. All risks likely to be material to the patient must be explored, as well as alternatives to the procedure. Despite this, departments and endoscopists still struggle to meet the current standards. In this article, we explore the challenges encountered in achieving individualised consent in therapeutic endoscopy through real-life scenarios. Methods Five realistic therapeutic endoscopy (hepatobiliary) scenarios are described, followed by presentation of possible or ideal approaches, with references related to existing literature in this field. Results The vignettes allow consideration of how to approach difficult consent challenges, including anxiety and information overload, urgency during acute illness, failure to disclose the risk of death, the role of trainees and intraprocedural distress under conscious sedation. Conclusions The authors conclude that a high degree of transparency is required while obtaining consent for therapeutic endoscopy accompanied by full documentation, involvement of relatives in nearly all cases, and clarity around the presence of trainees who may handle the scope. A greater focus on upskilling trainees in the consent process for therapeutic endoscopy is required.
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来源期刊
Frontline Gastroenterology
Frontline Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.70
自引率
11.50%
发文量
93
期刊介绍: Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
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