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Titolo:
Guidelines as rationing tools: a qualitative analysis of psychosocial patient selection criteria for cardiac procedures
Autore:
Giacomini, MK; Cook, DJ; Streiner, DL; Anand, SS;
Indirizzi:
McMaster Univ, Ctr Hlth Econ & Policy Anal, Hamilton, ON L8N 3Z5, Canada McMaster Univ Hamilton ON Canada L8N 3Z5 al, Hamilton, ON L8N 3Z5, Canada McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, CanadaMcMaster Univ Hamilton ON Canada L8N 3Z5 at, Hamilton, ON L8N 3Z5, Canada McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada McMaster Univ Hamilton ON Canada L8N 3Z5 ed, Hamilton, ON L8N 3Z5, Canada McMaster Univ, Dept Psychiat, Hamilton, ON L8N 3Z5, Canada McMaster Univ Hamilton ON Canada L8N 3Z5 at, Hamilton, ON L8N 3Z5, Canada Baycrest Ctr Geriatr Res, Toronto, ON, Canada Baycrest Ctr Geriatr Res Toronto ON Canada iatr Res, Toronto, ON, Canada Univ Toronto, Dept Psychiat, Toronto, ON, Canada Univ Toronto Toronto ON Canada ronto, Dept Psychiat, Toronto, ON, Canada
Titolo Testata:
CANADIAN MEDICAL ASSOCIATION JOURNAL
fascicolo: 5, volume: 164, anno: 2001,
pagine: 634 - 640
SICI:
0820-3946(20010306)164:5<634:GARTAQ>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
CLINICAL-PRACTICE GUIDELINES; AMERICAN-HEART-ASSOCIATION; CARDIOVASCULAR PROCEDURES COMMITTEE; CARDIOLOGY TASK-FORCE; HEALTH-CARE; TRANSPLANT CANDIDATES; CORONARY ANGIOPLASTY; MEDICAL LITERATURE; USERS GUIDES; COUNCIL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
98
Recensione:
Indirizzi per estratti:
Indirizzo: Giacomini, MK McMaster Univ, Ctr Hlth Econ & Policy Anal, 1200 Main St W,HSC-3H1C, Hamilton, ON L8N 3Z5, Canada McMaster Univ 1200 Main St W,HSC-3H1CHamilton ON Canada L8N 3Z5
Citazione:
M.K. Giacomini et al., "Guidelines as rationing tools: a qualitative analysis of psychosocial patient selection criteria for cardiac procedures", CAN MED A J, 164(5), 2001, pp. 634-640

Abstract

Background: Cardiac procedure guidelines often include psychosocial criteria for selecting patients that potentially introduce social value judgements into clinical decisions and decisions about the rationing of care. The aim of this study was to investigate the terms and justifications for and themeanings of psychosocial patient characteristics used in cardiac procedureguidelines. Methods: We selected English-language guidelines published since 1990 and chapters in textbooks published since 1989. These guidelines amalgamated multiple sources of evidence and expertise and made recommendations regardingpatient selection for specific procedures. A multidisciplinary team of physicians and social scientists extracted passages regarding psychosocial criteria and developed categories and conceptual relationships to describe andinterpret their content. Results: Sixty-five papers met the criteria for inclusion in the study. Forty-five (69%) mentioned psychosocial criteria as procedure indications or contraindications. The latter fell into several categories, including behavioural and psychological issues, relationships with significant others, financial resources, social roles and environmental circumstances. Interpretation: Psychosocial characteristics are portrayed as having 2 roles in patient selection: as risk factors intrinsic to the candidate or as indicators of need for special intervention. Guidelines typically simply list psychosocial contraindications without clarifying their specific nature or providing any justification for their use. Psychosocial considerations can help in the evaluation of patients for cardiac procedures, but they become ethically controversial when used to restrict access. The use of psychosocial indications and contraindications could be improved by more precise descriptions of the psychosocial problem at issue, explanations regarding whythe criterion matters and justification of the characteristic using a biological rationale or research evidence.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/04/20 alle ore 15:31:30