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dc.contributor.authorSchaufel, Margrethe Aaseeng
dc.contributor.authorNordrehaug, Jan Erikeng
dc.contributor.authorMalterud, Kirstieng
dc.date.accessioned2011-07-28T12:18:37Z
dc.date.available2011-07-28T12:18:37Z
dc.date.issued2009eng
dc.identifier.citationHeart 95(15): 1245-1249en_US
dc.identifier.issn1355-6037eng
dc.identifier.urihttp://hdl.handle.net/1956/4858
dc.description.abstractObjective: To explore doctor-patient interactions and decision-making processes before high-risk cardiac surgery or intervention with special attention to existential challenges. Design, setting and participants: We conducted a qualitative study with data drawn from doctor-patient dialogues preceding high-risk procedures. The study setting was the cardiac department of a university hospital with 24-hour emergency service. We recruited a purposive sample of 10 patients and eight doctors. The patients were categorised as high-risk patients in accordance with EuroSCORE and established angiographic procedural high-risk criteria. Transcripts from the dialogues were analysed with systematic text condensation, inspired by discourse analysis. Main outcome measure: Accounts of doctor-patient interaction reflecting existential aspects of the decisionmaking process. Results: The main existential concerns identified in the doctor-patient interactions were surviving uncertainty, negotiating responsibility and trusting the doctor’s proficiency. When handling uncertainty, doctors imparted complex information about risk, warnings and recommendations, while patients sought and trusted the doctors’ advice. Though the decisions were made in asymmetrical power relations, they were based on a shared responsibility discussed and defined throughout the dialogues. The patients expressed a profound confidence in the doctor’s ability to get them through the high-risk treatment and give the best help possible. Conclusions: Uncertainty, mortality, responsibility and trust are fundamental existential issues concerning both patients and doctors before high-risk procedures, with an impact on decision-making processes. Increasing focus on underlying existential conditions, ethical reasoning and power relations in medical education may improve the quality of shared decision-making and informed consent related to high-risk treatment.en_US
dc.language.isoengeng
dc.publisherBMJ Publishing Groupeng
dc.title‘‘So you think I’ll survive?’’: a qualitative study about doctor-patient dialogues preceding high-risk cardiac surgery or interventioneng
dc.typeJournal articleeng
dc.typePeer reviewedeng
dc.subject.nsiVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771eng
dc.subject.nsiVDP::Medical disciplines: 700::Health sciences: 800::Medical/dental ethics, behavioural sciences, history: 805eng
dc.rights.holderCopyright 2009 BMJ Publishing Group Ltd and the British Cardiovascular Society
dc.rights.holderBMJ Publishing Group Ltd and the British Cardiovascular Societyeng
dc.type.versionpublishedVersioneng
bora.peerreviewedPeer reviewedeng
bibo.doihttp://dx.doi.org/10.1136/hrt.2008.164657eng
dc.identifier.doihttp://dx.doi.org/10.1136/hrt.2008.164657


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