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目的研究对重症患儿作治疗决定时,医生或父母何方承担主要角色,以及由此对父母心理产生的影响。父母与医生在对重症患儿作治疗决定过程中应扮演的角色一直存在争议,欧美采用由父母决定生命支持模式,而在法国,医生通常被认为是决策者。设计通过直接观察进行定性分析。地点 4所PICU(法国2所,加拿大魁北克2所)对象 31位重症患儿的父母;曾治疗这些患儿的9位医生和13位护士。干预无测量指标与主要结果通过面谈对父母进行半指令性调查。在法国,医生在决定治疗过程中是主要决策者。在魁北克,父母是最主要的决策者,但有时医生也作决定,某些决定权取决于所做决定的类型。与魁北克父母比较,法国父母似乎更满足于和医生的关系与交流,更看重交流质量,而非由谁作决定。父母实际承担的决定权与其后的负疚感无关。结论无论法律和伦理规范如何界定,在医疗过程中,父母在一定程度上作主是不可避免的。这不一定会对父母的道德感造成伤害。父母在其他儿科场合的决策情况值得进一步研究。
Objectives To study where the doctor or parent plays a major role in the treatment of critically ill children and the impact they have on parental psychology. Parents and doctors have long been in dispute about the role they should play in making decisions about treatment of critically ill children. In Europe and the United States, life-support models are dictated by parents. In France, doctors are often considered policymakers. Design through direct observation of qualitative analysis. Place Parents of 31 critically ill children in 4 PICUs (2 in France and 2 in Quebec, Canada); 9 doctors and 13 nurses who had treated these children. Interventions None Measured Indicators and Major Outcomes Semi-mandatory investigation of parents through interviews. In France, doctors are the main decision makers in deciding on treatment. In Québec, parents are the most important decision makers, but sometimes doctors make decisions, some of which depend on the type of decision made. Compared with Quebec parents, French parents seem more satisfied with the doctor’s relationship and exchange, more emphasis on the quality of exchange, rather than who made the decision. Parents’ actual decision-making power has nothing to do with the subsequent sense of guilt. Conclusion No matter how the legal and ethical norms are defined, it is unavoidable for parents to be masters to some extent during the medical treatment. This does not necessarily hurt parents’ sense of morality. Parents in other pediatric situations decision-making worth further study.