Correlation between doctor`s belief on the patient`s self

Transcription

J Med Dent Sci 2013； 60： 23－40
Original Article
Correlation between doctor’s belief on the patient’s self-determination and
medical outcomes in obtaining informed consent
Keisuke Yoshihara1, 2) and Kozo Takase2)
1) Mejiro University, Department of Business Administration, Faculty of Business Administration, Graduate
School of Business Administration, Tokyo, Japan
2) Tokyo Medical and Dental University, Section of Research Development, Department of Public Health,
Graduate School of Medical and Dental Sciences, Tokyo, Japan
We employed a questionnaire survey to assess
attitudes toward informed consent (IC) among
hospital doctors. Based on the result of the
correlation analysis, the following two hypotheses
were identified. The first hypothesis is that “the
doctor’s belief that the patient’s self-determination
is possible promotes cure of illness by obtaining
IC.” The second hypothesis is that “the doctor’s
belief that the patient’s self-determination is
possible has a positive influence on patient’s
quality of life by obtaining IC.” We clarified the
rationale for explaining these two hypotheses by
applying cross tabulation analysis, discriminant
analysis and principal component analysis
(PCA). The doctors were divided into two groups
in terms of their position on the patient’s selfdetermination. One group of doctors believed the
possibility of patient’s self-determination, and the
other did not. Through our statistical analyses, the
characteristics that discriminate these two groups
were identified. It was revealed that the former
group placed a great importance on the hospitality
value, while the latter placed an importance on
the service value. Agreement or rejection of the
concept of IC has been demonstrated as a key
distinguishing factor between the two groups. The
results of PCA showed that the doctor’s belief on
Corresponding Author: Keisuke Yoshihara, MMA
Professor of the Department of Business Administration, Faculty of
Business Administration, Graduate School of Business Administration
4-31-1 Nakaochiai Shinjuku-ku Tokyo 161-8539, Japan
Tel: +81-3-5996-3241　Fax: +81-3-5996-3060
E-mail: [email protected]
Received September 27；Accepted November 16, 2012
the patient’s self-determination in obtaining IC had
a significant effect on medical outcomes, and the
two above-mentioned hypotheses were revealed.
Key words: hospitality, service, self-determination,
medical outcome
Introduction
The purpose of this study is to develop and validate
the hypotheses regarding informed consent (IC) for the
health care system in Japan and to examine if IC is
1
based on the hospitality concept among doctors . First,
we employed a questionnaire survey to assess the
attitudes toward IC among hospital doctors and the
effect of their thoughts on IC on the cure of illnesses.
Then, the hypotheses were developed based on the
questionnaire and their reliability was investigated.
IC mainly consists of agreement and consent from a
patient 2-7 and the explanations provided by doctor. It is
a concept that supports the patientʼs self-determination,
where an interdependent relationship between a doctor
and a patient brings a synergy effect on the cure of
illnesses. However, it is questionable if doctors
understand the concept of IC or use the opportunity of
obtaining IC effectively in their current practice.
The previous studies on IC have taken one of the
three following viewpoints: medical ethics as a
canon 2, 3, 8, communication between a doctor and a
patient 9-11, and an interpretation of the legal aspects of
I C 2 , 1 2 . The first viewpoint analyzed IC from the
perspective of the medical ethics explained by Bai 8
based on the idea that IC is “the patient’s consent and
the doctor’s explanations in regard to a medical
t r e a t m en t .” T he s e c ond appr o a ch in v ol v e d t h e
24
J Med Dent Sci
K. Yoshihara et al.
investigation of the role of IC as a part of communication
in medical care. The third approach involved legal
aspects of IC. These studies display regard for value
judgment, but deficit in management perspective in
consideration of IC as a specific implementation.
The present study can be employed as a fourth way of
approach to elucidate the significance of IC embodied
both the service concept and the hospitality concept.
When refer to the preceding studies 9, 13, the concept
of service was perceived as economic activities based
on economic incentives, where the providers provide
useful functionalities or activities to the recipients in
one-way direction and the recipients pay a fee to the
providers10. Although IC is one of the medical processes
involved in providing service for the patient, we cannot
use the service concept only in obtaining IC since
service is a one-way process from a giver (doctor) to a
taker (patient), and IC is not based solely on an idea of
efficiency either. The service value is the precondition
for the hospitality value to be formed. Therefore, IC
must be explained by the hospitality concept as well as
the service concept.
Unlike the service concept, the hospitality concept
allows doctors and patients to confront illnesses
together 4, 14-16. Patients want to know the diagnoses and
symptoms as well as prognoses of their illnesses, and
the explanation of the doctor brings a sense of security
on them. According to Seiichi Washida 4, rather than
physicians simply explaining, it is important that they
wait and watch how and what patients will talk about.
They can increase their empathy by listening actively
to the patients to understand them as individuals and to
build relationships with them. IC should be performed
through mutual creation by doctors and patients to
maximize the hospitality value, if IC is supposed to be
based on the hospitality concept. Otherwise, the
relationship between doctors and patients would
become one-way and manual-like as explained in the
service concept. The hospitality concept is bidirectional
and mutually complimentary, and it makes neither the
doctor nor the patient in charge of their relationship.
The present study was therefore conducted with both
service and hospitality concepts in mind by identifying
the distinguishing characteristics of the group of doctor
who think that the patient’s self-determination is
possible and those who do not. Then, the effect of
doctor’s intentions such as emphasizing the hospitality
value and encouraging the patient’s self-determination
on medical outcomes was examined.
Materials and Methods
We conducted a questionnaire survey to achieve the
aims of this study. In this study, our discussion is limited
to the situation in which IC is obtained from the patients
who are receiving medical care for the curable acute
illnesses and are able to make medical decisions.
Subjects of the Investigation:
Doctors working in hospitals with 200 to 900 beds
mainly in Kanto area of Japan were chosen as the
target of this study. The selection criterion for the
survey targets was that the hospital itself was able to
cooperate and expressed that multiple departments
within the hospital were able to cooperate. We chose
five hospitals and distributed fifty questionnaire sheets
to each hospital facility in order to collect data from a
total of 250 doctors. The questionnaire was selfadministered voluntarily and anonymously by doctors.
Questionnaire:
We constructed a questionnaire that consists of 24
multiple choice items (See Appendix 2). The items in the
questionnaire were divided into four categories: Ⅰ)
Hospital Management (four items); Ⅱ) Doctor’s Intentions
(ten items); Ⅲ) Relationship with Patients (six items); and
Ⅳ) Medical Outcomes (four items). From each category,
we identified the current situation of IC from the
viewpoint of doctors (See Table 1).
20 of the 24 questions had four to seven choices,
and the respondents had to choose one best answer.
For example, it is as follows in the case of X6, to what
extent do you honor patient’s requests for the
disclosure of the medical records and other details?
Circle one of the numbers below (one answer only). The
five answers are as follows: 1) I strongly honor such
requests; 2) I honor such requests to a certain degree;
3) Sometimes I do, sometimes I donʼt; 4) I usually donʼt
honor such requests; and 5) I never honor such
requests. Other items were multiple-answer questions.
Methods and Study Period:
The survey was first explained to the doctors and the
questionnaire sheets were left at the hospitals for them
to fill out voluntarily and anonymously. The questionnaire
sheets were collected a few days later. The study was
performed from October 20 to December 22, 2008.
Details of the analysis:
We examined the correlations between IC and
“Medical Outcomes” and the other three categories,
which are “Hospital Management,” “Doctor’s Intentions,”
and doctor’s “Relationship with Patients.” The numerical
points are assigned to the answer choices for each
25
Patient’s self-determination and medical outcomes
Table 1. Questionnaire for the survey.
X1 Organizational awareness of IC
X2 Practical application of IC
X3 Adequacy of time for IC
X4 Communication between hospital personnel
X5 Agreement or rejection of the concept of IC
X6 Willingness to disclose patient’s medical information
X7 Level of recognition/understanding of hospitality
X8 Level of practice of hospitality
X9 Level of conviction about future healthcare system
X10 Point of emphasis in the explanation to patients
X11 Extent of information disclosure to patients
X12 Preparations before carrying out IC
X13 Expectations for the patients at the time of IC enforcement
X14 Possibility of patient’s self-determination
X15 Posture of acceptance toward patients during IC enforcement
X16 Level of friendliness toward patients
X17 Level of generosity toward patients
X18 Emphasis on empathy and the sense of unity with patients when
obtaining IC
X19 Emphasis on building a trusting relationship with patients
X20 Desirable relationship between doctor and patient
X21 Effect of IC on disease prognosis
X22 Influence of IC on patient’s quality of life
X23 Positive effects of IC
X24 Effect of IC on the number of patients
I. Hospital Management (X1- X4: 4 items)
II. Doctor’s Intentions (X5- X14: 10 items)
III. Relationship with Patients (X15- X20: 6 items)
IV. Medical Outcomes (X21- X24: 4 items)
Likert items; for example, the numerical points for each
answer selection in X21 is shown below: 1) Strongly
agree: 5 points; 2) Somewhat agree: 4 points; 3) I don’t
particularly agree or disagree: 3 points; 4) Somewhat
disagree: 2 points; 5) Strongly disagree: 1 point.
We focused on the correlation between doctor’s
intentions and the medical outcomes (See Table 1). The
correlations between the doctor’s belief on the
possibility of the patient’s self-determination (X5, 9, 11,
and 14) and positive influences of IC on the treatment
of disease (X21 and 22) were analyzed. X5, 9, 11, and
14 are essential scale variables from the viewpoint of
patients for the concept of IC in correlation analysis.
The discriminant analysis was performed to elucidate
the influencing factors that distinguish the two groups
assigned by the response to X14. The eight items (X2,
3, 5, 6, 8, and 18-20) were used as the explanatory
variables. The dependent variable was taken from X14.
X5, 6, and 18-20 were included in the analysis since
they showed marked difference during the cross
tabulation analysis (See Appendix 1). X2, 3, and 8 were
not listed in Appendix 1 since they did not have a high
significant difference compared to X5, 6, and 18-20,
but they are included in the discriminant analysis as the
scale variables. X21, 22, and 23 were excluded
because they were in the medical outcomes section
and were irrelevant as explanatory variables. X7, 10,
and 13 were not included in Table 5 because they were
not scale variables.
We also performed PCA on the factors influencing
medical outcomes to clarify the rationale behind the
two hypotheses developed from this study. A total of 13
survey questions were selected from the three survey
categories, “Hospital Management,” “Doctor’s Intentions,”
and “Relationship with Patients,” for the use as scale
variables in PCA with the exception of X6, “Willingness
to disclose patient’s medical information.” The doctors
were then classified into four groups according to the
combinations of the positive and negative loadings of
the selected principal components.
Analysis of variance ANOVA was also carried out to
determine whether there was a statistically significant
difference in the responses to X21, “Effect of IC on
disease prognosis,” and X22, “Influence of IC on
patient’s quality of life,” under “Medical Outcomes”
section depending on the doctor’s intent (i.e., PC 1,
“Emphasis on the hospitality value,” and PC 3, “Intent to
encourage patient’s self-determination”). The Tukey
method, considered the most common multiple
comparison method, was employed to demonstrate the
rationale behind the hypotheses.
Statistical Analysis:
Excel‐Toukei 2008 (Social Survey Research
Information Co., Ltd. Software Products Group, Tokyo,
Japan) was used for statistical analysis. A P-value of
less than 0.05 was considered statistically significant in
discriminant analysis.
Results
A total of 250 questionnaires were distributed and
168 were collected. Among them, we analyzed 165
responses that contained effective answers. Thus, the
effective reply rate was 66.0%.
The demographic data of the respondents were as
follows (See Table 2). The sex ratio of the 165 doctors
was 81.2% men and 17.6% women. Among the
respondents, 39.4% were in their 30s, which was the
most common age group of the doctors we investigated,
and 29.7% were in their 40s. 41.3% of the respondents
have been working as a doctor for less than ten years,
26
J Med Dent Sci
K. Yoshihara et al.
Table 2. Demographic data of respondents
Table 3. Specialties of the respondents.
Sex
Internal medicine
Psychosomatic
medicine
Male: 81.2％
Female: 17.6％
No answer: 1.2％
Age
20-29 years old: 15.2％
30-39 years old: 39.4％
40-49 years old: 29.7％
50-59 years old: 12.1％
60-69 years old: 3.0％
No answer: 0.6％
Less than 5 years: 15.8％
Number of years
More than 5 years less than 10 years: 25.5％
practicing as a
doctor
More than 20 years: 26.7％
No answer: 0.6％
Number of beds in Less than 20 beds: 7.9％
More than 200 beds less than 500 beds: 21.8％
the hospital they
work at
More than 900 beds: 13.9％
No answer: 3.6％
Number of staffs at Less than 50 people: 3.0％
More than 50 people less than 100 people: 6.1％
the hospital they
work at
More than 500 people: 69.8％
No answer: 13.3％
and doctors working in the hospitals with 700 to 900
beds were most common (41.8%). The most common
specialty was general surgery (16.4%), followed by
orthopedics (10.9%), internal medicine, and
ophthalmology (9.7% in both) (See Table 3).
The correlation coefficient between X14 and X21
was 0.24 (p < 0.01), and that between X14 and X22
was also 0.24 (p < 0.01). From the result of the
correlation analysis, the following two hypotheses were
identified (See Table 4). The first hypothesis is that “the
doctor’s belief that the patient’s self-determination is
possible promotes cure of illness by obtaining IC.” The
second hypothesis is that “the doctor’s belief that the
patient’s self-determination is possible has a positive
influence on patient’s quality of life by obtaining IC.”
A linear discriminant function was derived to
distinguish between the two groups: the doctors who
think patient’s self-determination is possible and those
who do not, and “Agreement or rejection of the concept
of IC” has been identified as a key influencing factor
(See Table 5).
Each principal component (PC) was then interpreted
based on their respective loadings. PC 1 had a large
Gastrointestinal
Cardiovascular
9.7%
－
3.6%
2.4%
Neurosurgery
1.2%
Cardiovascular
surgery
Plastic and
cosmetic surgery
0.6%
－
Obstetrics and
gynecology
7.9%
Diabetes
－
Urology
4.2%
Geriatric medicine
－
Pediatrics
Ear, Nose and
Throat (ENT)
Dermatology
Ophthalmology
Dentistry
4.8%
Rheumatology
2.4%
Hematology
Respiratory
Nephrology
1.2%
4.2%
0.6%
Neurology
General Surgery
Orthopedics
1.8%
16.4%
10.9%
Total
6.7%
0.6%
9.7%
－
Anesthesiology
Others
No answer
4.2%
6.1%
0.6%
100.0%
Table 4. Correlation between the doctor’s belief on
possibility of patient’s self-determination and positive
influences of IC on the treatment of diseases
X5 Agreement or rejection of
the concept of IC
X9 Level of conviction about
future healthcare system
X11 Extent of information
disclosure to the patients
X14 Possibility of patient’s
self-determination
X21 Effect of IC
on disease
prognosis
X22 Influence of
IC on patient’s
quality of life
0.20**
0.22**
0.08
0.05
-0.07
0.02
0.24**
0.24**
N=165, Level of significance **p < 0.01
positive loading for the communication-related variables
such as “Posture of acceptance toward patients during
IC enforcement,” “Level of friendliness toward patients,”
“Level of generosity towards patients,” “Emphasis on
empathy and sense of unity with patients when
obtaining IC,” and “Emphasis on building a trusting
relationship with patients.” These loads can be seen as
indicative of “Emphasis on the hospitality value.” PC 2
had a large positive loading for the variables such as
“Organizational awareness of IC,” “Practical application
of IC,” and “Communication between hospital personnel,”
which can be interpreted as “Hospital’s emphasis on the
service value.” PC 3 had a relatively large positive
loading for the variables such as “Agreement or
rejection of the concept of IC” and “Possibility of
patient’s self-determination.” Since the notion of IC is to
27
Table 5. Discriminant analysis for influencing factors separating the doctors who think patient’s self-determination is possible
and those who do not.
distinction coefficient
-0.097
-0.212
-0.724
-0.282
-0.11
-0.084
-0.286
0.06
X6 Willingness to disclose patient’s medical information
X8 Level of practice of hospitality
X18 Emphasis on empathy and the sense of unity with the patients when obtaining IC
X20 Desirable relationship between doctor and patient
P value
0.704
0.31
0.014 *
0.416
0.602
0.759
0.447
0.747
N=165, Level of significance *p < 0.05
Table 6. PCA about 13 items.
X1 Organizational awareness of IC
X4 Communication between hospital personnel
X9 Level of conviction about future healthcare system
X11 Extent of information disclosure to patients
X14 Possibility of patient’s self-determination
X15 Posture of acceptance toward patients during IC enforcement
X16 Level of friendliness toward patients
X17 Level of generosity toward patients
X18 Emphasis on empathy and the sense of unity with patients when obtaining IC
explanatory power
PC 1
0.35
0.26
0.19
0.12
0.27
0.26
0.04
0.24
0.54
0.65
0.71
0.75
0.64
20.16
PC 2
0.71
0.69
0.42
0.58
0.27
-0.15
0.17
0.19
0.11
-0.37
-0.22
-0.25
-0.23
15.21
PC 3
-0.28
-0.33
0.26
0.15
0.61
0.03
-0.38
0.68
-0.26
-0.14
-0.06
0.1
0.01
10.56
PC 4
-0.22
-0.34
0.51
0.39
-0.12
0.58
0.19
-0.32
0.23
-0.12
-0.24
0.05
0.09
9.21
PC 5
0.02
-0.01
-0.43
-0.08
0.42
0.39
0.69
0.07
-0.2
-0.19
0.04
-0.06
0.1
8.43
N=165. Five PCs with eigenvalues greater than one were selected with a cumulative explanatory power of 63.6%. The figures indicate the positive or
negative loading of each principal component (PC). Figures exceeding the absolute value of 0.5 are represented in bold.
support the patient in making decisions, these loadings
can be construed as “Intent to encourage patient’s selfdetermination” (See Table 6).
Difference between means was then determined
using a t-test to identify the correlation between PC 3,
“Intent to encourage patient’s self-determination,” and
“Medical Outcomes” specified in the hypotheses. Of the
five PCs identified as a result of PCA, PC 1, “Emphasis
on the hospitality value,” and PC 3, “Intent to encourage
patient’s self-determination,” were used to classify
doctors into the following four groups according to their
positive or negative loading: Group1 (+ +)) Positive
loading (+) for both PC 1 and PC 3; Group 2 (+ -))
Positive loading (+) for PC 1, and negative loading (-)
for PC 3; Group3 (- +)) Negative loading (-) for PC 1,
and positive loading (+) for PC 3; Group 4 (- -)) Negative
loading (-) for both PC 1 and PC 3. Statistical testing
was then done to determine whether there were any
significant intergroup differences in their responses to
X21, “Effect of IC on disease prognosis,” and X22,
“Influence of IC on patient’s quality of life” (See Table 7).
One-way ANOVA was done to investigate the
influence of the intentions of doctor on responses to
X21, “Effect of IC on disease prognosis.” The results
showed that the doctor’s intent did indeed have a
significant effect on the responses (F (3,155) = 3.7300;
p < 0.05). Similarly, ANOVA was performed to determine
the influence of the intentions of doctor on X22,
“Influence of IC on patient’s quality of life”. The results
showed that the doctor’s intent significantly influenced
the responses (F (3,155) = 4.0155; p < 0.01).
Multiple comparison test (Tukey) revealed a
significant difference in the responses to X21 and X22
between Group 1 (+ +) and Group 4 (- -) (See Table 8).
These findings demonstrated that doctors with a high
level of intention to emphasize the hospitality value and
28
Table 7. Descriptive statistics for X21, “Effect of IC on
disease prognosis.” and X22, “Influence of IC on patient’s
quality of life.”
Sample size
[+ +] Group 1
[+ -] Group 2
[- +] Group 3
[- -] Group 4
J Med Dent Sci
K. Yoshihara et al.
39
38
48
34
Mean
X21
X22
3.897
4.000
3.763
3.684
3.750
3.813
3.235
3.294
SD
X21
X22
0.718
0.795
0.943
0.989
0.729
0.867
1.208
0.938
N=165.
to encourage patient’s self-determination tended to
have a more positive influence on the “Effect of IC on
disease prognosis” and “Influence of IC on patient’s
quality of life.”
Discussion
The statistical results of this study supported the
following two hypotheses: 1) The doctor’s belief that
the patient’s self-determination is possible promotes
cure of illness by obtaining IC and 2) The doctor’s belief
that the patient’s self-determination is possible has a
positive influence on patient’s quality of life by obtaining
IC.
These findings demonstrate that a doctor’s attitude
towards PC 1, “Emphasis on the hospitality value,” and
PC 3, “Intent to encourage patient’s self-determination,”
strongly influences his or her perception of the “Effect
of IC on disease prognosis” and “Influence of IC on
patient’s quality of life,” with PC 3 having a larger
influence than PC 1. These are the most essential
elements of IC because its concept supports the
patient’s self-determination, and a doctor and a patient
should have an interdependent relationship, where
there is a synergy effect on the cure of illnesses.
The results of this study also suggest that all doctors
must have a universal understanding of the concept of
IC in order for IC to function as intended. As shown in
Table 5, the sufficient distinction coefficient (-0.724)
was significant enough to conclude that “Agreement or
rejection of the concept of IC” is the key influencing
factor under a significance level of 5%. Thus, the
decisive factor that distinguished the doctors who think
that the patient’s self-determination is possible and
those who do not was whether they agree or reject the
concept of IC. It is important to recognize that this
Table 8. Post-ANOVA multiple comparison test (Tukey) of
X21 “Effect of IC on disease prognosis” and X22 “Influence
of IC on patient’s quality of life”
Set of
group
1
1
1
2
2
3
2
3
4
3
4
4
X21
Evaluation
P value
0.9134
0.8718
0.0109 *
0.9999
0.0660
0.0559
X22
Evaluation
P value
0.4118
0.7657
0.0054 **
0.9118
0.2562
0.0520
N=165, Significance level: * 95% ** 99%
factor influences the effect of obtaining IC in turn. The
result indicated that the group of doctors thinking that
the patient’s self-determination is possible showed
characteristics such as empathy, a sense of unity, and
confidence in their relationship with patients. They had
a tendency to improve the effect of IC on the cure of
diseases by building a relationship that encourages the
patients themselves to decide the method of treatment.
The findings of the present study demonstrate that
emphasizing the hospitality value is an effective way to
embody the principle of IC. In this regard, we believe
that our study has contributed to promote the proper
use of IC within health care system in Japan. IC has
conventionally been viewed as a patient service, but
our study has shown that it cannot be defined solely
from the perspective of service. Providing care under
the service value may be a prerequisite to creating the
hospitality value, but it is not enough to generate
patient satisfaction because it is one-way direction and
is based on the idea of enhancing the efficiency. There
is an inherent risk that doctors take an obligatory and
defensive approach under the service value. The group
of doctors who think the patient’s self-determination is
impossible was characterized by the tendency to place
great importance on accountability regarding the risks
involved in the treatment, side effects, and negative
consequences. The findings revealed that their ideal
relationship with their patients is a functional relationship
in which the doctor is a provider and the patient is a
recipient.
The group of doctors in the present study who believed
that patients were capable of making decisions regarding
their own treatment tended to use IC effectively as a
patient’s self-determination tool. They were obtaining IC
in the knowledge that their relationship with their patient
is based on a sense of empathy, community, and trust,
as shown in Table 5. These doctors also had an intention
to provide patients with various medical information
and alternatives to facilitate informed decision-making.
Through efforts such as this, doctors can create joy and
delight beyond satisfaction in patients by empowering
them to make their own decisions, and it will inevitably
lead to the creation of the hospitality value. Needless to
say, when the doctor is obtaining IC from the patient, it
is important to ensure that the patient makes a decision
with a clear understanding of the treatment risks, side
effects, and prognosis that are predicted. However, by
changing their current awareness and attitudes, doctors
can encourage patients to become more independent
and autonomic in their self-determination.
The study results highlight the benefits of shifting
from the conventional service-based approach of IC,
where the doctor simply explains to the patient in oneway direction, to a more sympathetic approach where
the doctor considers the patient’s wishes and feelings.
In other words, the findings suggest that implementing
IC with a greater emphasis on the hospitality value
may support to alleviate patients’ concerns and build
a trusting relationship with them17-19. These outcomes
are compatible with the fundamental philosophy of IC
as well as the hospitality concept. The creation and
delivery of the hospitality would not only lead to patient
satisfaction, but also create joy and delight in them
and has an added benefit of enhancing the capacity of
the hospital personnel who apply the hospitality value
into their practice 5, 13. Thus, emphasizing the hospitality
value constitutes an incentive for management to
develop a hospital that is distinct from other facilities.
The findings showed that the group of doctors who
believed in the patient’s self-determination ability saw
IC as a valid and meaningful tool that has an impact
on patient’s healing and quality of life. The results
also suggest that the doctors who adopt a more
positive attitude toward IC may experience a drastic
improvement in the problems they face such as patient
adherence and medical litigation 20-23 . An effective
use of IC may even have a positive influence on the
medical expense as well as the burden and shortage of
health care providers by enabling more effective use
of patient resources as the relationship with patients
develop 24.
As a results in Table 8, a significant difference in the
responses to X21 and X22 was also seen between
Group 3(- +) and Group 4(- -). These findings
demonstrated that doctors with a low level of intention
to emphasize the hospitality value and a high level of
intention to encourage patient’s self-determination
tended to have a more positive influence on the “Effect
of IC on disease prognosis” and “Influence of IC on
29
patient’s quality of life” than the doctors who had low
level for both PCs. In future research, we will attempt to
elucidate the contents of Group 3(- +) and improve the
accuracy of the hypotheses supported in this study by
conducting interview surveys. We also hope to identify
the benefits of patient participation in the creation of
the hospitality value. The development of theoretical
and practical guidance on the use of IC in health care
settings is a pressing issue, and we hope that this study
will be a beneficial aid in achieving this objective.
Acknowledgements
We are grateful to Professor Yohichi Kataoka (Mejiro
University Graduate School of Business Administration)
for supporting the study, and Mrs. Kanako Maeda
(Tokyo Medical and Dental University) for preparing the
manuscript. We wish to thank many people who
assisted with the questionnaire survey. We received
from Mejiro University special research funds for three
years from 2008.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
References
National Institute of Population and Social Security
Research, Collection of population statistics documents
2011 (in Japanese).
Medical ethic question and answer publication Committee.
A medical ethic question and answer. Taiyo shuppan (in
Japanese). 2005.
Yoshitake K. The medical ethic and agreement formation,
on-site decision making of treatment/the care. Toshindou
(in Japanese). 2007.
Washida S. The power of listening: A clinical philosophy
preliminary essay. TBS Britannica (in Japanese). 1999.
Tanida N. The informed consent misunderstanding/
perversion/correct answer. NPO medical care bijirannsu
center (in Japanese). 2006.
Faden RR，Beauchamp TL. A history and theory of
informed consent. Oxford University Press. 1986.
Osuna E, Perez-Carceles MD, Perez-Moreno JA, et al.
Informed consent: Evaluation of the information provided
to patients before anesthesia and surgery. Med Law.
1998; 17: 511-518.
Bai K. Step to medical affairs law. Iwanami Shoten (in
Japanese). 1970.
Kondo T. An introduction to service management.
Seisanseishuppan (in Japanese). 1995.
Maeda S, editor. Informed consent, the theory and format
example (in Japanese). 2005.
Saeki H, Takashima S, Doi Hiroyoshi Hara. How to
advance informed consent in the breast cancer. Cancer
treatment and host. 1993; 5(2) (in Japanese).
Kuroyanagi T, Takase K, Maeda J. A plain medical trial
30
13.
14.
15.
16.
17.
18.
19.
20.
K. Yoshihara et al.
p r e s c r i p t i o n — d o c t o r / n u r s e m u s t r e a d . H a n r e i
taimuzusha (in Japanese). 2004.
Albrecht K. The only thing that matters. Harper Collins
Publishers Inc. 1992.
Yoshihara K. Hospitality leadership. Hakutoushobou (in
Japanese). 2005.
Scherer R. Zeus Hospitalier. Armand Colin Editeur. Paris;
1993．
Strull WM, Lo B, Charles G.. Do patients want to participate
in medical decision making?. JAMA. 1984; 252: 29902994.
Blackhall LJ, Murphy ST, Frank G, et al. Ethnicity and
attitudes toward patient autonomy. JAMA. 1995; 274:
820-825.
Breaugh JA. The work autonomy scales, additional
validity evidence. Human Relations. 1989; 421033-1056．
Kawahara K. A medical plan and policy structure of
healthy Japan 21. Public Health. J. Natl. Inst. 2001; 50(4)
(in Japanese).
Nakanishi M. “Of the decision of the patient in the
informed consent shakes; a study on correspondence of”
21.
22.
23.
24.
J Med Dent Sci
and the nurse. Research funds assistance fundamental
researches. B results of research report scientific in
1995 (in Japanese).
Nishigaki E, Asai A, Onishi M, et al. Trust for the
Japanese medical care and structure of the distrust.
Interpersonal social psychology study 4 (in Japanese).
2004.
Yoshihara K. Study on framework of hospitality
management (Ⅰ). Japanese Journal of Hospitality
Management of Research. HOSPITALITY, The eleventh
Japanese Academic Society of hospitality management
Yoshihara K. Study on framework of hospitality
management (Ⅱ). Japanese Journal of Hospitality
Management of Research. HOSPITALITY. The twelfth
Japanese Academic Society of hospitality management
Charles W Lidz, Loren H Roth. The signed form-informed
consent?. In: Robert F, Boruch, et al, editors. Solutions to
ethical and legal problems in social research. New York:
Academic Press;1983. p. 145-57.
31
Appendix 1. Cross tabulation of answers to the 12 selected items by the doctors who think patient’s self-determination is
possible and those who do not.
Possibility of self-determination by the patient
Total
Possible
Impossible
(n=165)
(n=101)
(n=64)
IC and doctor’s Intentions
X5 Agreement or rejection of the concept of
IC
“Strongly agree”
49%(81)
59% (60)
33%(21)
X6 Willingness to disclose patient’s medical
information
“I Strongly honor such requests”
56%(93)
61% (62)
48% (31)
X7 Level of recognition/understanding of
hospitality
“I Know the word but I do not fully
understand what is meant by hospitality”
11% (18)
6% (6)
19% (12)
X10 Point of emphasis in the explanation to
patients
“Details, aims, necessity, rationale and
efficacy of the alternative treatments”
16% (27)
23% (23)
6% (4)
“Aims and details of testing”
50% (82)
44% (44)
59% (38)
“Risks and side effects associated with the
treatments”
78%(129)
72% (73)
88% (56)
“Aftereffects associated with the treatments”
“Understanding the patientʼs wishes, feelings
and thoughts”
27％ (44)
44% (73)
23% (23)
33% (21)
50% (50)
36% (23)
“I want patients to show a capacity for
understanding and acceptance for what their
physicians have to say”
50% (82)
55% (56)
41% (26)
“I want patients to develop an understanding
of the conceivable risks”
52% (85)
45% (45)
63% (40)
X18 Emphasis on empathy and the sense of
unity with the patients when obtaining IC
22% (37)
28% (28)
14% (9)
X19 Emphasis on building a trusting
relationship with patients
47% (78)
52% (53)
39% (25)
X20 Desirable relationship between doctor
and patient
“The physician and the patient maintain a
relationship in which the doctor informs the
patient his options and the patient makes his/
her decision regarding the treatment method”
39% (64)
46% (46)
28% (18)
“The physician and the patient maintain a
functional relationship in which the doctor
provides the patient with medical treatment
techniques and so forth, while the patient
assumes the role of accepting what the
doctor provides”
20% (33)
13% (13)
31% (20)
“Somewhat agree”
45% (74)
52% (53)
33% (21)
X22 Influence of IC on patient’s quality of
life
“It has a moderate impact”
38% (62)
43% (43)
30% (19)
X23 Positive effect s of IC
“Fosters an attitude that conveys a respect
for the decisions made by patients”
62%(102)
68% (68)
53% (34)
X12 Preparations before carrying out IC
X13 Expectations for the patients at the time
of IC enforcement
IC and the relationship with the Patients
IC and medical outcomes
X21 Effect of IC on disease prognosis
N=165. The numbers in parentheses express the actual numbers, and the underlines indicate the group that has higher percentage compared to total. Next,
the respondents were divided into two groups based on their response to the possibility of the patient’s self-determination (X14), and the cross tabulation
analysis was performed to examine whether the difference in their perspectives would be reflected in their answers to other items (See Appendix 1). The
cross tabulation analysis was performed about all questions. The table shows only the questions in which the higher percentage of doctors in either group
has chosen the particular answer than the percentage of the total number, and they are X5, 6, 7, 10, 12, 13, 18, 19, 20, 21, 22, and 23. These questions
were supposed to be the characteristic items that indicated a conspicuous gap in the cross tabulation analysis.
32
K. Yoshihara et al.
J Med Dent Sci
33
34
K. Yoshihara et al.
J Med Dent Sci
35
36
K. Yoshihara et al.
J Med Dent Sci
37
38
K. Yoshihara et al.
J Med Dent Sci
39
40
K. Yoshihara et al.
J Med Dent Sci

Correlation between doctor`s belief on the patient`s self

Transcription

Similar documents

TEFCU HOSPITALITY COMMUNITY FEDERAL CREDIT UNION

What We Wish Our Parents Knew

Arjun Rampal Poster - Ogaan Cancer Foundation

Sivica Hospitality

INTRODUCING PASABAHCE PROFESSIONAL

welcome to eyedentity

Rule the Real Talk

Cardiolite Treadmill Stress Test

Doctors` Day - Guymon Daily Herald