نوع مقاله : مقاله پژوهشی
نویسندگان
1 دانشیار، مدیریت اطلاعات سلامت، دانشگاه علوم پزشکی کاشان، کاشان، ایران
2 استادیار، مدیریت اطلاعات سلامت، دانشگاه علوم پزشکی تهران، تهران، ایران
3 دانشجوی کارشناسی ارشد، آموزش مدارک پزشکی، دانشگاه علوم پزشکی کاشان، کاشان، ایران
چکیده
مقدمه: بیماران بر اساس حق استقلال فردی می‌توانند پس از دریافت اطلاعات کامل، آگاهانه و داوطلبانه از درمان یا ادامه‌ی آن امتناع نمایند. این پژوهش با هدف شناسایی دلایل امتناع از درمان، میزان امتناع و آگاهانه بودن امتناع از درمان انجام شد.
روش بررسی: این مطالعه از نوع توصیفی- مقطعی بود. جامعه‌ی پژوهش تمامی 135 بیمار امتناع کننده از درمان در بیمارستان‌های آموزشی شهر کاشان (به استثنای مرکز روانپزشکی) در سه ماهه‌ی تابستان 1389 بودند. داده‌ها به وسیله‌ی پرسش‌نامه‌ای شامل 35 سؤال که روایی و پایایی آن کنترل شده بود، به روش مصاحبه جمع‌آوری شد. داده‌ها با استفاده از نرم‌افزار SPSS و با آمار توصیفی مورد تحلیل قرار گرفت.
یافته‌ها: مهم‌ترین دلایل ترخیص با رضایت شخصی بیماران، نداشتن شرایط روحی مناسب (83 درصد)، کیفیت کم مراقبت‌ها
(49 درصد) و توصیه‌ی دوستان و خویشاوندان (5/35 درصد) بود. در رابطه با ابعاد اخذ رضایت آگاهانه در ترخیص با رضایت شخصی، بیماران معتقد بودند که ارایه‌ی اطلاعات به ایشان در 2/64 درصد موارد، قابل درک بودن فرم ترخیص با میل شخصی در 2/69 درصد موارد و تعامل و ارتباط پزشک با بیمار در زمان دریافت رضایت‌نامه‌ی ترخیص با میل شخصی در 72 درصد موارد، مناسب یا به طور تقریبی مناسب بوده است.
نتیجه‌گیری: بهبود شرایط روحی بیمار و ارتقای سطح کیفی خدمات پزشکی و امکانات درمانی می‌تواند منجر به کاهش میزان ترخیص با رضایت شخصی شود. به منظور بهبود کیفیت اخذ رضایت‌نامه، ترخیص با رضایت شخصی، لازم است سایر گزینه‌های درمانی به همراه منافع و عوارض هر یک و همچنین محتویات فرم رضایت‌نامه برای بیماران توضیح داده شود و پزشکان ضمن پی بردن به دلایل امتناع بیماران از درمان و درک آن‌ها، سعی در برطرف نمودن دلایل و منصرف نمودن بیمار نمایند.
کلیدواژه‌ها
عنوان مقاله [English]
Rate of Informed Decision-Making for Treatment Refusal in University Hospitals of Kashan, Iran*
نویسندگان [English]
- Mehrdad Farzandipour 1
- Abbas Sheikhtaheri 2
- Monireh Sadeghi Jabali 3
1 Associate Professor, Health Information Management, Kashan University of Medical Sciences, Kashan, Iran
2 Assistant Professor, Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
3 MSc Student, Medical Records, Kashan University of Medical Sciences, Kashan, Iran
چکیده [English]
Introduction: Based on individual independence rights, patients can refrain from being treated or
can voluntarily discontinue their treatment after receiving full information. This study aimed to
review the reasons of treatment refusal and the status of informed refusals for patients.
Methods: This was a cross-sectional descriptive study. The study population included 135
patients who refused to be treated in university hospitals of Kashan (except for the Psychiatric
ward) during summer 2010. Data were collected through a 35-item questionnaire by means of
interviewing. The data were analyzed using SPSS software.
Results: The most important common reasons for treatment refusals were patients’ inappropriate
feelings for hospitalization continuation (83%), low quality of hospital services (49%) and
receiving advices from their friends and families (35.5%). Providing information before signing
the consent form (64.2%), understandability of the consent form (69.2%) and interaction between
the patient and the physician (72%) were items with adequate or somewhat adequate status
mentioned by the patients.
Conclusion: Improving status of hospitalization, mental condition, and patient tendency to be
hospitalized and also promoting health quality can result in decreasing personal satisfaction for
discharges against medical advices. To improve the status of informed refusals, more information
about alternatives, their benefits and complications, and content of consent forms should be
provided to patients. Physicians should understand patients’ reasons to refuse treatment and try to
eliminate obstacles and persuade them to continue their treatments.
کلیدواژه‌ها [English]
- Patient Discharge
- Consent Form
- Informed Consent
- Patient Rights
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