BACKGROUND:Flame injury confers significant physical and psychologic stress on burn patients. Because most patients and their surrogates lack an understanding of burn injury, and these injuries preclude the meaningful exercise of patient autonomy, informed consent is a challenge for physicians. To better promote patient autonomy, this project collected patient perspectives on the proper duties of patients and physicians after severe burn injury and throughout the recovery phases. STUDY DESIGN:Ten survivors of severe burn injury were prospectively identified to represent different causes of injury, support systems, and socioeconomic backgrounds. Six persons participated (4 men, 2 women). Personal interviews with these individuals discussed their perspective and experience regarding physician and patient duties after severe burn injury as they relate to patient autonomy. RESULTS:All participants thought that informed consent was unrealistic at the time of their injury, but that this capacity developed over time as their understanding and level of functioning improved. In addition, all believed that the burn physicians' role was to do whatever was medically best for their patients in an emergency situation, but that this duty included the physician educating the patient or surrogates about what these treatments entail. CONCLUSIONS:Patient autonomy may be an unrealistic goal acutely for patients with severe burn injuries. Educational approaches to consent may facilitate patient autonomy, participation in decision making, and adherence to care plan over time. The ethical framework for this approach has been accepted in rehabilitation literature, but this is the first demonstration that relevant patient populations agree with this approach.

译文

背景:火焰伤害给烧伤患者带来巨大的生理和心理压力。由于大多数患者及其代理人缺乏对烧伤的理解,并且这些伤使患者无法自主行使有意义的自主权,因此,知情同意对医生来说是一个挑战。为了更好地促进患者的自主权,该项目收集了患者对严重烧伤后以及整个康复阶段患者和医生的适当职责的看法。
研究设计:前瞻性鉴定了十名严重烧伤的幸存者,他们代表不同的受伤原因,支持系统和社会经济背景。六人参加(4名男性,2名女性)。对这些人的个人访谈讨论了他们在严重烧伤后对医师和患者职责的看法和经验,因为它们与患者的自主权有关。
结果:所有参与者都认为受伤时知情同意是不现实的,但是随着他们的理解和功能水平的提高,这种能力随着时间的推移而发展。此外,所有人都认为烧伤医师的作用是在紧急情况下尽其所能为患者做最适合自己的药物,但是这项职责包括医师对患者进行教育或对这些疗法的含义进行替代。
结论:对于重度烧伤患者,患者自主性可能是一个不切实际的目标。同意的教育方法可以促进患者的自主权,参与决策以及随着时间的推移遵守护理计划。康复文献已经接受了这种方法的伦理框架,但这是有关患者人群同意这种方法的第一个证明。

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