Pediatrician’s perspectives on discharge against medical advice (DAMA) among pediatric patients a qualitative study 英文参考文献.docVIP

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Pediatrician’s perspectives on discharge against medical advice (DAMA) among pediatric patients a qualitative study 英文参考文献.doc

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Pediatrician’s perspectives on discharge against medical advice (DAMA) among pediatric patients a qualitative study 英文参考文献

MacrohonBMCPediatrics2012,12:75 /1471-2431/12/75 RESEARCH ARTICLE OpenAccess Pediatrician’sperspectivesondischargeagainst medicaladvice(DAMA)amongpediatricpatients: aqualitativestudy BernadetteCMacrohon* Abstract Background:Thephenomenonofdischargeagainstmedicaladvice(DAMA)amongpediatricpatientsplaces pediatriciansinadilemmabetweenrespectfortheparent’sdecisionandthedesiretoprovidecompletecarefor thevulnerablechild-patient.Littlehasbeenwrittenaboutfactorsthataffectapediatrician’sdecisiontoallowa parenttodischargehischildagainstmedicaladvice.Thisqualitativestudyaimstoanswerthequestionofhow pediatricresidentsinatertiarygovernmenthospitalperceiveanddecideonaDAMArequestfromaparentor primarycaregiver. Methods:Usingafocusgroupdiscussionapproach,11pediatricresidentsfromagovernment-runtertiaryhospital wererecruitedforthestudy.Thesessionwasdigitallyrecordedanddominantthemeswerecodedandidentified. Results:Therewerethreeprominentthemesthataroseinthediscussion:variabilityofdefinitionsofDAMA,factors consideredbefore“allowing”thepatienttobeDAMA,andtheimplicationsofaDAMArequestontheir performanceaspediatricians.DefinitionsvaryfromoneresidenttoanotherbasedonthemainreasonforDAMA (terminal,cultural,orfinancial).AconflictwasnotedinthedefinitionofHomeperRequest(HPR)versusDAMA. FactorsthatinfluenceapediatriciantosignoutacaseasDAMAinclude:theirabilitytodosomethingaboutthe reasongivenfortheDAMArequest,theconditionofthepatientwhentheDAMArequestwasgiven,their impressionofthekindofcarethattheparentsprovide,andtheirlegalliabilities.Pediatricresidentsgenerally maintainapositiveattitudetowardstheparentswhorequestforDAMAandintheeventofreadmission,accept thepatientintotheircareagain. TheoccurrenceofavarietyofdefinitionsandsubcategoriesforDAMAmaycauseconfusionamongthe pediatriciansandshouldbeclarified.Thefamiliaritywithculturaltraditionscontributestotheirabilitytohandle situationsthatmayleadtoDAMAbutthisshouldalwaysbeconsideredinthecontextofthepediatrician’ slegal liabilities.Theattitudeofbeingh