Análise das variáveis demográficas, sociais, econômicas e culturais no processo de tomada de decisão: estudo em pacientes oncológicos avançados, cuidadores e médicos
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Data
2010-08-26
Autores
Borges, Marcos Aristóteles [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Apesar do reconhecimento da importância da participação do doente na tomada de decisões médicas, apenas recentemente os profissionais de saúde vem se conscientizando da necessidade de informá-los sobre as opções de tratamento e da necessidade de encorajá-los a participar de tais decisões. É escasso o conhecimento sobre o processo de tomada de decisão, sobre as preferências dos pacientes e de como melhorar a comunicação com pacientes, cuidadores e familiares. Os objetivos do presente estudo foram: avaliar as possíveis diferenças entre as preferências no processo de tomada de decisão pelos pacientes, cuidadores e médicos; e avaliar se as preferências dos pacientes durante a tomada de decisões estão relacionadas às variações demográfico-sócio-econômico-culturais. Foi elaborado protocolo de pesquisa, utilizando-se instrumentos validados, para ser empregado nas entrevistas com doentes, cuidadores e médicos. Os pacientes preferem compartilhar a decisão de tratamento com a família em 57,5% dos casos e preferem que o médico decida seu tratamento em 62% das vezes. Há concordância em informar o diagnóstico para 94,5% dos doentes, 95% dos familiares e 92,5% dos médicos. Também há aceitação de que o doente deva ser informado do prognóstico para 65% dos pacientes, 72,5% dos familiares e 82,5% dos médicos. O grau de concordância sobre as preferências de tratamento entre as respostas fornecidas pelo paciente e as respostas fornecidas pelo médico resultou em Kappa = 0,0227, o que significa baixa concordância. As variáveis demográfico-sócio-econômico-culturais não influenciaram as preferências do paciente frente ao papel da família. As preferências em relação à escolha do tratamento por parte do doente, do familiar e do médico revelam percepções diferentes, e estes são incapazes de predizer as preferências do doente. No presente estudo não se...
Despite what is known about the importance for patients to participate in the decision-making process, just in recent times health professionals are becoming aware of the need to inform patients about the treatment options and also encourage them to take the lead in medical decisions. The decision-making process concerning patient participation and how to improve communication among patients, caregivers and family members is scarce. The aim of this study was: to evaluate possible differences among the decision-making process comparing patients, caregivers and physicians choices and evaluate whether patients preferences during the decisionmaking process are related to variations in demographic, socio-economic and cultural levels. A research protocol was created, using validated instruments to be used in interviews with patients, caregivers and physicians. Patients prefer to share treatment decision with the family in 57.5% of cases and prefer that the doctor decides for the treatment in 62% of the situations. There is an agreement that the diagnosis must be informed for 94.5% of the patients, 95% of the families and 92.5% of the doctors. There is also acceptance that the patient should be informed of the prognosis for 65% of the patients, 72.5% of the families and 82.5% of the physicians. The agreement level between the answers given by the patients and the answers given by their doctors about treatment preferences resulted in Kappa = 0.0227, which means low agreement. The demographic and socio-economic variables did not influenced the patient preferences towards the family. Preferences regarding the choice of treatment by patient, family and physician showed different perceptions, and physicians are unable to predict the preferences of the patient. This study showed no correlation in the preferences of the patient, the caregiver and the physician in the decision-making process. Likewisi, ... (Complete abstract click electronic access below)
Despite what is known about the importance for patients to participate in the decision-making process, just in recent times health professionals are becoming aware of the need to inform patients about the treatment options and also encourage them to take the lead in medical decisions. The decision-making process concerning patient participation and how to improve communication among patients, caregivers and family members is scarce. The aim of this study was: to evaluate possible differences among the decision-making process comparing patients, caregivers and physicians choices and evaluate whether patients preferences during the decisionmaking process are related to variations in demographic, socio-economic and cultural levels. A research protocol was created, using validated instruments to be used in interviews with patients, caregivers and physicians. Patients prefer to share treatment decision with the family in 57.5% of cases and prefer that the doctor decides for the treatment in 62% of the situations. There is an agreement that the diagnosis must be informed for 94.5% of the patients, 95% of the families and 92.5% of the doctors. There is also acceptance that the patient should be informed of the prognosis for 65% of the patients, 72.5% of the families and 82.5% of the physicians. The agreement level between the answers given by the patients and the answers given by their doctors about treatment preferences resulted in Kappa = 0.0227, which means low agreement. The demographic and socio-economic variables did not influenced the patient preferences towards the family. Preferences regarding the choice of treatment by patient, family and physician showed different perceptions, and physicians are unable to predict the preferences of the patient. This study showed no correlation in the preferences of the patient, the caregiver and the physician in the decision-making process. Likewisi, ... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Anestesiologia, Processo decisorio, Oncologia, Médico e paciente, Patient preferences, Decision making
Como citar
BORGES, Marcos Aristóteles. Análise das variáveis demográficas, sociais, econômicas e culturais no processo de tomada de decisão: estudo em pacientes oncológicos avançados, cuidadores e médicos. 2010. 95 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.