背景:今天,以人为本的护理被视为卫生政策和实践的基石,但是适应个体患者的喜好可能是具有挑战性的,例如涉及产妇要求剖腹产(CSMR)。这项研究的目的是探索瑞典卫生专业人员对CSMR的看法,并分析它们可能因以人为本的护理而产生的潜在冲突。特别是在共同决策方面。
方法:基于半结构化访谈,进行了使用归纳和演绎内容分析的定性研究。这是基于对12名卫生专业人员的有目的的抽样:7名产科医生,在瑞典南部和中部的不同医院工作的三名助产士和两名新生儿科医生。采访记录在电话或视频电话会议中,音频文件在转录后被删除。
结果:在访谈中,出现了十二种类型的表达式(子类别),即共享决策与CSMR之间的五种类型的冲突(类别)。大多数卫生专业人员原则上同意妇女有权决定自己的身体,但不相信这包括选择没有医学指征的手术的权利(患者自主权)。卫生专业人员还表示,他们不仅要考虑女性目前的喜好和健康状况,还要考虑她未来的健康状况,这可能会受到CSMR(治疗质量和患者安全)的负面影响。此外,卫生专业人员在个人决定中没有考虑成本,但认为CSMR可能会导致挤出效应(避免伤害他人的治疗)。尽管卫生专业人员强调每个CSMR请求都是单独处理的,他们提到避免任意性的不同策略(平等和不歧视)。最后,他们描述了CSMR需要一个多方面的决定,既是个人又是集体的,和使用出生合同,以增加妇女的安全感(一个简单的决策过程)。
结论:处理瑞典CSMR的复杂景观,源于以集体和标准化解决方案为中心的限制性方法,同时转向以人为本的护理和个人决策,在卫生专业人员的推理中很明显。尽管大多数卫生专业人员强调分娩方式最终是一个专业决定,他们仍然努力通过信息和支持实现共同决策。鉴于对CSMR的不同看法,对于医疗保健专业人员和妇女来说,就如何解决这一问题达成共识,并讨论在这一特定背景下患者自主权和共同决策意味着什么,这一点至关重要。
今天,以人为中心的护理是一种普遍的方法,但是适应个体患者的喜好可能是具有挑战性的,例如涉及产妇要求剖腹产(CSMR)。这项研究考察了瑞典卫生专业人员对CSMR的看法。对12名卫生专业人员的访谈揭示了CSMR与以人为中心的护理的关键方面之间的冲突。特别是共同决策。虽然专业人士承认妇女的自主权,他们在没有医疗需要的情况下质疑CSMR。关注包括例如治疗质量和患者安全,避免伤害他人的治疗。瑞典的背景,平衡集体解决方案与个性化护理,使决策复杂化。与拥有更多私人医疗保健的国家不同,CSMR支持可能更高,尽管将分娩方式主要视为专业决策,但瑞典卫生专业人员仍强调共同决策。这项研究揭示了将CSMR整合到以人为中心的护理框架中所面临的挑战。
BACKGROUND: Today, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals\' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.
METHODS: A qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.
RESULTS: In the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman\'s current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman\'s sense of security (an uncomplicated decision-making process).
CONCLUSIONS: The complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals\' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context.
Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals’ views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women’s autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.