میزان آگاهانه بودن امتناع از درمان در بیمارستان‌های آموزشی شهر کاشان

نوع مقاله : مقاله پژوهشی

نویسندگان
مهرداد فرزندی‌پور 1
عباس شیخ طاهری 2
منیره صادقی جبلی 3
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
1. Opala JM, Sanbar SS. Informed consent and informed refusal in Oklahoma. J Okla State Med Assoc 2009;
102(3): 86-91.
2. Faden R, Faden A. False belief and the refusal of medical treatment. J Med Ethics 1977; 3(3): 133-6.
3. Gerbasi JB, Simon RI. Patients' rights and psychiatrists' duties: discharging patients against medical advice. Harv
Rev Psychiatry 2003; 11(6): 333-43.
4. Moskop JC. Informed consent and refusal of treatment: challenges for emergency physicians. Emerg Med Clin
North Am 2006; 24(3): 605-18.
5. Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical
advice? CMAJ 2003; 168(4): 417-20.
6. Weingart SN, Davis RB, Phillips RS. Patients discharged against medical advice from a general medicine service.
J Gen Intern Med 1998; 13(8): 568-71.
7. Ibekwe RC, Muoneke VU, Nnebe-Agumadu UH, Amadife MA. Factors influencincing discharge against medical
advice among paediatric patients in Abakaliki, Southeastern Nigeria. J Trop Pediatr 2009; 55(1): 39-41.
8. Ikefuna AN, Emodi IJ. An Assessment of Factors influencing Hospital Discharges Against Medical Advice of
Paediatric Patients in Enugu: A Review of 67 Cases. Nigerian Journal of Paediatrics 2002; 29(1): 1-4.
9. Nasir AA, Babalola OM. Clinical spectrum of discharges against medical advice in a developing country. Indian
J Surg 2008; 70(2): 68-72.
10.Okechukwu A. Discharge against medical advice in children at the University of Abuja Teaching Hospital,Gwagwalada, Nigeria. Journal of Medicine and Medical Science 2011; 2(7): 949-54.
11.Rangraz Jeddi F, Rangraz Jeddi M, Rezaeiimofrad M. Patients' Reasons for Discharge against Medical Advice in
University Hospitals of Kashan University of Medical Sciences in 2008. Hakim 2010; 13(1): 33-9. [In Persian].
12. Kabirzade A, Rezazade S, Mohseni Saravi B. Prevalence and causes of patient self discharge against medical advice in
children of Boo-Ali Hospital in Sari in 2009. J North Khorasan Univ Med Sci 2011; 2(4): 57-62. [In Persian].
13. Eze B, Agu K, Nwosu J. Discharge against medical advice at a tertiary center in southeastern Nigeria:
sociodemographic and clinical dimensions. Patient Intelligence 2010; 2: 27-31.
14.Green P, Watts D, Poole S, Dhopesh V. Why patients sign out against medical advice (AMA): factors motivating
patients to sign out AMA. Am J Drug Alcohol Abuse 2004; 30(2): 489-93.
15.Onukwugha E, Saunders E, Mullins CD, Pradel FG, Zuckerman M, Weir MR. Reasons for discharges against
medical advice: a qualitative study. Qual Saf Health Care 2010; 19(5): 420-4.
16. Selbst SM. Leaving against medical advice. Pediatr Emerg Care 1986; 2(4): 266-8.
17. Shirani F, Jalili M, Asl-E-Soleimani. Discharge against medical advice from emergency department: results from
a tertiary care hospital in Tehran, Iran. Eur J Emerg Med 2010; 17(6): 318-21.
18.Bramstedt KA, Nash PJ. When death is the outcome of informed refusal: dilemma of rejecting ventricular assist
device therapy. J Heart Lung Transplant 2005; 24(2): 229-30.
19.Alfandre DJ. "I'm going home": discharges against medical advice. Mayo Clin Proc 2009; 84(3): 255-60.
20.Aliyu ZY. Discharge against medical advice: sociodemographic, clinical and financial perspectives. Int J Clin
Pract 2002; 56(5): 325-7.
21.Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O'Shaughnessy MV. Leaving hospital against medical
advice among HIV-positive patients. CMAJ 2002; 167(6): 633-7.
22.Baptist AP, Warrier I, Arora R, Ager J, Massanari RM. Hospitalized patients with asthma who leave against
medical advice: characteristics, reasons, and outcomes. J Allergy Clin Immunol 2007; 119(4): 924-9.
23.Choi M, Kim H, Qian H, Palepu A. Readmission rates of patients discharged against medical advice: a matched
cohort study. PLoS One 2011; 6(9): e24459.
24.Devitt PJ, Devitt AC, Dewan M. Does identifying a discharge as "against medical advice" confer legal
protection? J Fam Pract 2000; 49(3): 224-7.
25.Grisso T, Appelbaum PS, Hill-Fotouhi C. The MacCAT-T: a clinical tool to assess patients' capacities to make
treatment decisions. Psychiatr Serv 1997; 48(11): 1415-9.
26. Simon JR. Refusal of care: the physician-patient relationship and decisionmaking capacity. Ann Emerg Med
2007; 50(4): 456-61.
27. Sheikhtaheri A, Farzandipour M. Factors Associated with Quality of Informed Consent in Patients Admitted for
Surgery: An Iranian Study. AJOB Primary Research 2010; 1(4): 9-16.
28.Roodpeyma S, Eshagh Hoseyni SA. Discharge of children from hospital against medical advice. World journal of
pediatrics 2010; 6(4): 353-6.
29.Bhurgri H, Qidwai W. Awareness of the process of informed consent among family practice patients in Karachi.
J Pak Med Assoc 2004; 54(7): 398-401.                                                                                                                                       30.McKeague M, Windsor J. Patients' perception of the adequacy of informed consent: a pilot study of elective
general surgical patients in Auckland. N Z Med J 2003; 116(1170): U355.
31. San JA, San JR, Zuza B, Zunzarren F, Luri T. [Aspects of pre-operational information of the patient in
emergency surgery]. An Sist Sanit Navar 2000; 23(3): 509-16.
32. Jeremiah J, O'Sullivan P, Stein MD. Who leaves against medical advice? J Gen Intern Med 1995; 10(7): 403-5.
33. Vahdat SH, Hesam S, Mehrabian F. Effective factors on patient discharge with own agreement in selected Therapeutic
Training Centers of Ghazvin Shahid Rajaei. Journal of Community Nursing 2011; 20(64): 47-52. [In Persian].
34. Joffe S, Cook EF, Cleary PD, Clark JW, Weeks JC. Quality of informed consent in cancer clinical trials: a crosssectional
survey. Lancet 2001; 358(9295): 1772-7.
35.Gotay CC. Perceptions of informed consent by participants in a prostate cancer prevention study. Cancer
Epidemiol Biomarkers Prev 2001; 10(10): 1097-9.
36. Sheikhtaheri A, Farzandipour M. Informed Consent Process: Inpatients Competency and Admission Clerks'
Performance in Teaching Hospitals in Kashan. Health Inf Manage 2009; 6(2): 96-104. [In Persian].
37. Sheikhtaheri A, Farzandipour M, Sadughi F. Consumer`s satisfaction with admission services in teaching hospitals
affiliated to Kashan University of Medical Sciences 2006. J Health Adm 2007; 10(29): 15-24. [In Persian].
38.Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and
trust. Arch Fam Med 2000; 9(10): 1156-63.
مدیریت اطلاعات سلامت
دوره 9، شماره 5
آذر و دی 1391
صفحه 646-654