Dunphy, Bruce; Dunphy, Stacey; Cantwell, Robert; Bourke, Sid; Fleming, Mark
Evidence based-practice and affect : the impact of physician attitudes on outcomes associated with clinical reasoning and decision-making
Teil von
  • Australian journal of educational & developmental psychology, 2010-01-01, Vol.10 (2010), p.56-64
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The relationship between obstetrician attitudes and patient outcomes from intrapartum care was examined. Obstetrician attitudes were assessed utilising a newly-designed pilot 35-item obstetrician attitude questionnaire (OAQ). Twelve obstetricians completed the OAQ, who provided intra-partum care to 4,149 women. Outcome measures included delivery mode and intrapartum asphyxia. Analysis was carried out using logistic regression. A number of OAQ items were significantly associated with outcome. The significance of some of these items may be explained by past clinical experience and attitudes toward certain aspects of clinical care including acceptable intervention rates and risk of patient harm associated with certain procedures. However, the importance of other attitudes was less predictable including an increased incidence of normal delivery associated with a stronger belief in the art of clinical practice (not the evidence-based nature of practice), openness to considering the wishes of the woman in labour was associated with less neonatal asphyxia, and attitudes toward the impact of sleep deprivation on decision-making were associated with intervention rates. In conclusion, obstetrician attitudes appear to have a significant impact on maternal and neonatal outcomes from intrapartum care. Clinical and theoretical implications of the findings are discussed, and further development of the OAQ is recommended. [Author abstract]

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