Expectativas de los pacientes sobre la toma de decisiones ante diferentes problemas de salud

Informed consent: A study of patients with life-threatening illnesses

BACKGROUND

The relationship between healthcare professionals and patients in the Spanish health sector has undergone dramatic change. One aspect of this is that the use of informed consent has become a key factor in the delivery of adequate healthcare. But although a certain period of time has already passed since informed consent started to be used, in Spain there is still doubt about how adequately informed consent is being used.

OBJECTIVES

(a) To look at how patients understand the notion and purpose of informed consent, and (b) how the informed consent is applied - the way patients receive such information affects their level of participation and decision making during the time they receive medical care.

METHODOLOGY

We use interpretative description of interviews with patients. We developed guiding questions for the interviews with patients in two preliminary and exploratory focus groups. Then, we carried out 20 personal open-ended interviews with 20 purposive selected patients with illnesses that had a serious impact on their lives. Ethical considerations: Permission from ethical committees and institutions involved in the study, and consent and confidentiality were ensured before conducting the research.

RESULTS

The findings show that while patients agreed that their consent should be necessary for health professionals to be able to intervene, they had serious difficulty obtaining and then understanding information offered to them at the moment when they were being asked to sign informed consent documents. The participants were critical of the consent documents, which they considered were treated as merely a formality and even some of them had felt coerced to sign.

DISCUSSION

Participants confirmed that the informed consent documents that they signed did not meet their ethical objectives. Their perception of the purpose of consent indicates that informed consent document may still be largely understood as a formality rather an ethical obligation.

The principle of autonomy in Brazil: one needs to discuss it

The principle of patient autonomy is a cornerstone of bioethics. According to this concept, patients should be given the power to make decisions related to their treatment. It is an important component of modern medical ethics, which has received much interest in current literature. However, the rate of participation of patients and their willingness to participate are variable according to the cultural, social and family environments in which they are inserted. The aim of this paper is to promote a brief descriptive review on autonomy, the preferences of patients and the use of informed consent as an instrument for the exercise of autonomy in literature, and to stress the lack of debate, as well as the pressing need for discussion of these current issues nationwide.

[Community diagnosis using qualitative techniques of expectations and experiences in a health area in need of social transformation]

OBJECTIVE

To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS).

DESIGN

Qualitative methodology (exploratory study).

LOCATION

Urban basic health zone (16,000 inhabitants, 40% ZNTS).

PARTICIPANTS

Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic.

MAIN INTERVENTIONS

Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders).

ANALYSIS

transcription of speeches, coding, categories triangulation and final outcome.

RESULTS

Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attention's discontinuity primary care/hospital. There's bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. There's good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. There's a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users.

CONCLUSION

The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care.

Do the media provide transparent health information? A cross-cultural comparison of public information about the HPV vaccine

The media is a powerful tool for informing the public about health treatments. In particular, the Internet has gained importance as a widely valued source for health information for parents and adolescents. Nonetheless, traditional sources, such as newspapers, continue to report on health innovations. But do websites and newspaper reports provide balanced information? We performed a systematic media analysis to evaluate and compare media coverage of the human papillomavirus (HPV) vaccine on websites and in newspapers in Germany and Spain. We assessed to what extent the media provide complete (pros and cons), transparent (absolute instead of relative numbers), and correct information about the epidemiology and etiology of cervical cancer as well as the effectiveness and costs of the HPV vaccine. As a basis for comparison, a facts box containing current scientific evidence about cervical cancer and the HPV vaccine was developed. The media analysis included 61 websites and 141 newspaper articles in Germany, and 41 websites and 293 newspaper articles in Spain. Results show that 57% of German websites and 43% of German newspaper reports communicated correct estimates of epidemiological data, whereas in Spain 39% of the websites and 20% of the newspaper did so. While two thirds of Spanish websites explicitly mentioned causes of cervical cancer as well as spontaneous recovery, German websites communicated etiological information less frequently. Findings reveal that correct estimates about the vaccine's effectiveness were mentioned in 10% of German websites and 6% of German newspaper reports; none of the Spanish newspaper reports and 2% of Spanish websites reported effectiveness correctly. Only German websites (13%) explicitly referred to scientific uncertainty regarding the vaccine's evaluation. We conclude that the media lack balanced reporting on the dimensions completeness, transparency, and correctness. We propose standards for more balanced reporting on websites and in newspapers.

[Preferences, satisfaction level of patient participation in making decisions in health centre nursing clinics]

AIMS

To assess patient preferences their satisfaction level and their participation in decision making with nurses.

METHODS

Cross-sectional and mixed quantitative-qualitative study carried out in people attending the nursing services of 9 Health Centres in Andalusia. Patients were interviewed immediately after receiving nursing treatment using two different questionnaires for assessing their opinions, satisfaction and perception of involvement in the decisional process. A descriptive analysis using the χ(2) test (P<.05) was performed to assess the differences among close-ended and open-ended questions. Qualitative analysis: Open-ended questions were grouped into categories by a process involving three researchers independently.

RESULTS

A total of 235 patients took part, of whom 59% (138) preferred a collaborative role with the nurse when making decisions. In the closed questions, 96.2% (228) of the surveyed patients declared to be satisfied or very satisfied with the decision making process; nevertheless 17.4% (41) made specific suggestions for improving this process. For them the main improvement areas were related to: general communication skills or a more specific one such as: strategies for helping them make decisions, reaching common ground or giving advice.

CONCLUSIONS

Nurses should be aware that most patients wish to be involved in decision making and in clinical practice this participation can be improved by obtaining specific communicational skills. Surveys that include open-ended questions are more useful to assess the quality of care.

[Patient opinion and perception of their participation in family medicine consultation decision making]

OBJECTIVES

To find out the views of the patient on their participation in decision making (DM) when visiting their family physician.

DESIGN

A cross-sectional, qualitative and quantitative study.

SETTING AND PARTICIPANTS

Patients attending their family doctors in diverse geographical Health Centres.

MEASUREMENTS

Personal interviewing using different kinds of questions (close-ended, close-ended with options and open-ended questions).

RESULTS

Patients participation: 658 (52 ± 17.4 years, 62% females, consulting with 97 doctors (from urban centres: 36 (458); rural centres: 22 (200). Most patients (94%; 620) declared to be satisfied with DM and up to 41% (266) thought that DM should be taken only by the doctor. Nevertheless, after the consultation 60% of patients (360) confirmed that they would have liked the physician to have asked them for their opinion, but the doctor did not encourage them to do this. Furthermore, patients considered information, discussion about options, ways to make decisions, medical advice, active listening and empathy as key aspects to encourage them to participate.

CONCLUSIONS

After a medical consultation, most patients wanted to give their opinion about the proposals of treatment. Nevertheless, they felt that their doctors offered them these opportunities on very few occasions. Some types of questions are better than others in detecting of these kinds of needs, and are more useful to design strategies for involving patients in the DM process.