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Yıl:2022; Cilt: 25; Sayı: 2>> Özet
TAM METİN
Klinik Psikiyatri Dergisi; 2022;25(2):177-183
Gri bölgedeki karar verme kapasitesi vakalarına ilişkin acil servis ve psikiyatri hekimlerinin görüşlerinin karşılaştırılması
HO Sonkut, Ş Tosun Altınöz, A Coşkun, AE Altınöz
Eskisehir
Amaç: Bu çalışmanın amacı, farklı meslek gruplarından değerlendiricilerin, aynı olgular üzerinden karar verme süreçlerinin hem kendi aralarında hem de diğerleriyle olan uzlaşma düzeyini ortaya koymaktır. Yöntem: Karar verme kapasitesi (KVK) ile ilgili gri alanda üç vaka ve altı soru ile çevrimiçi bir anket oluşturulmuştur. Anketler, katılımcılara e-posta adresleri üzerinden gönderilmiştir. Çalışmaya toplam 165 hekim katılmıştır. Senaryolardan birincisi, anstabil gastrointestinal kanaması ve majör depresyonu olan bir hastanın tıbbi önerilere karşın, taburcu olma talebiyle ilgiliydi. İkinci senaryo, ciddi astım atağı ile pulmoner yetmezlik sınırında olan hastanın taburculuk talebini içermekteydi. Son senaryo ise evsiz bir bireyin alkol yoksunluğu belirtilerinin olduğu anda ortaya çıkan göğüs ağrısının kalp krizi dışlanmadan taburculuk talebi hakkındaydı. Bulgular: Psikiyatri uzmanlarının %54'ü, psikiyatri araştırma görevlilerinin %77'si, acil tıp uzmanlarının %82'si ve acil tıp araştırma görevlilerinin %76'sı senaryo 1 için KVK’nin korunduğunu belirtmiştir. Senaryo 2 için bu oranlar %88, %90, %76, %71 iken senaryo 3 için sırasıyla %44, %35, %44 ve %47 olarak bulunmuştur. Psikiyatristler ve araştırma görevlileri arasında sadece senaryo 1'de iki grup arasında istatistiksel olarak anlamlı bir fark bulunmuştur. Sonuç: Literatürle uyumlu olarak, önemli sayıda vakada farklı tıp dalları arasında KVK kararlarının tutarlılığının düşük olduğu gözlendi. Farklılıklar, farklı deneyim yılı, eğitim farklılıkları, temel karar verme yetkinliklerinin farklı önem dereceleriyle değerlendirilmesi ve malpraktis kaygılarındaki farklılıklar ile açıklanabilir.
Comparison of emergency department and psychiatry physicians’ views on decisionmaking capacity cases in the grey zone
Objective: The aim of this study is to demonstrate the level of reconciliation between different medical branches, decision-making processes over the same facts, both among themselves and with others. Method: An online survey was created with three cases and six questions in the grey area related to the decision-making capacity (DMC) situations. Surveys were sent to participants through their e-mails registered in hospital systems. A total of 165 physicians participated in the study. The first scenario concerned an unstable patient with gastrointestinal bleeding and major depression requesting discharge despite medical advice. The second scenario included the discharge request of a patient who was on the border of pulmonary insufficiency with a severe asthma attack. The final scenario was about a homeless person with chest pain that occurred at the time of alcohol withdrawal, demanding discharge, at a point where a heart attack wasn’t excluded. Results: 54% of psychiatry specialists, 77% of psychiatry residents, 82% of emergency medicine specialists and 76% of emergency medicine residents stated that DMC was intact for scenario 1. For scenario 2, these rates were determined as %88, %90, %76, %71 while for scenario 3 they were %44, %35, %44 and 47%, respectively. Among the psychiatrists and residents, a statistically significant difference was found between the two groups only in scenario 1. Discussion: : Consistent with the literature, it was observed that the interrater agreement of DMC decisions between different medical branches was low. Differences can be explained by different experience years, educational differences, evaluating basic decision-making competencies with different degrees of importance and differences in malpractice concerns.

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