Patient Preference and Shared Decision Making
-
摘要: 循证医学提倡医务人员应用证据并考虑患者价值和偏好作出决策。医患共同决策基于医患双方均为"专家"的理念, 即医生作为医学专家提供医学专业意见, 而患者作为了解自身偏好的专家, 双方在充分讨论后共同作出医学决策。在此过程中, 医务人员应同时具备获取最佳证据以及应用决策辅助系统实现医患共同决策的能力。本文通过比较不同医学决策模式, 讨论医患共同决策的理论与实践, 并列举与中国医疗环境相关的、医患共同决策可能面临的挑战与障碍因素, 以期为临床作出合理决策以及提高医疗服务质量提供借鉴。Abstract: Evidence-based medicine calls for consideration of the best available evidence and incorporation of patient values and preferences in health care decisions. The rationale of shared decision making is that both physicians and patients are experts, the physicians on medicine and the patients on their own preferences. Thus, it is essential for physicians and patients to exchange their expertise and make decisions together. To realize shared decision making in practice, physicians need to learn how to acquire the best available evidence, and how to use the decision aid to implement the shared decision making.This article compares different decision making approaches, and discusses the theory, practice, and the barriers to shared decision making specifically in China, aiming to support better clinical decision making and improvement of healthcare quality.
-
Key words:
- patient preference /
- shared decision making /
- evidence-based medicine /
- decision aid
利益冲突 无 -
[1] Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine:what it is and what it isn't[J]. BMJ, 1996, 312:71-72. https://pubmed.ncbi.nlm.nih.gov/8555924/ [2] Gordon G, Drummond R, Maureen OM, et al. Users' Guides to the Medical Literature:Essentials of Evidence-Based Clinical Practice[M]. 3rd ed. New York:McGraw Hill Professional, 2014:1-697. [3] Elwyn G, Frosch D, Thomson R, et al. Shared decision making:a model for clinical practice[J]. J Gen Intern Med, 2012, 27:1361-1367. [4] Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter:what does it mean? (or it takes at least two to tango)[J]. Soc Sci Med, 1997, 44:681-692. [5] 洪霞.医患共同决策[J].协和医学杂志, 2018, 9:276-280. http://www.cnki.com.cn/Article/CJFDTotal-XHYX201803016.htm [6] Gillon R. Medical ethics:four principles plus attention to scope[J]. BMJ, 1994, 309:184-188. https://www.researchgate.net/publication/15155348_Medical_Ethics_Four_Principles_Plus_Attention_to_Scope [7] Street RL Jr, Elwyn G, Epstein RM. Patient preferences and healthcare outcomes:an ecological perspective[J]. Expert Rev Pharmacoecon Outcomes Res, 2012, 12:167-180. http://orca.cf.ac.uk/43300/ [8] Cvengros JA, Christensen AJ, Cunningham C, et al. Patient preference for and reports of provider behavior:impact of symmetry on patient outcomes[J]. Health Psychol, 2009, 28:660-667. http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1000&context=psychology_pubs [9] 赵小明, 吴光怀.医患共同决策诊疗模式对社区精神障碍患者服药依从性及临床疗效的影响[J].中国医学工程, 2017, 25:16-18. http://www.cnki.com.cn/Article/CJFDTotal-YCGC201712005.htm [10] Guyatt GH, Oxman AD, Kunz R, et al. Going from evidence to recommendations[J]. BMJ, 2008, 336:1049. [11] Elwyn G, Durand MA, Song J, et al. A three-talk model for shared decision making:multistage consultation process[J]. BMJ, 2017, 359:j4891. https://pubmed.ncbi.nlm.nih.gov/29109079/ [12] Informed Medical Decisions Foundation, Richard W. Six Steps of Shared Decision Making[EB/OL].https: //www.mainequalitycounts.org/image_upload/SixStepsSDM2.pdf. [13] Agoritsas T, Heen AF, Brandt L, et al. Decision aids that really promote shared decision making:the pace quickens[J]. BMJ, 2015, 350:g7624. https://www.bmj.com/content/350/bmj.g7624 [14] Stacey D, Legare F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions[J]. Cochrane Database Syst Rev, 2017, (4):Cd001431. https://pubmed.ncbi.nlm.nih.gov/28402085/ [15] Holmes-Rovner M. International Patient Decision Aid Standards (IPDAS):beyond decision aids to usual design of patient education materials[J]. Health Expect, 2007, 10:103-107. https://www.ncbi.nlm.nih.gov/pubmed/17524003 [16] Tamhane S, Rodriguez-Gutierrez R, Hargraves I, et al. Shared Decision-Making in Diabetes Care[J]. Curr Diab Rep, 2015, 15:112. [17] Mayo Clinic Shared Decision Making National Resource Center. Diabetes Medication Choice Decision Conversation Aid[EB/OL].https: //diabetesdecisionaid.mayoclinic.org/index. [18] Gravel K, Legare F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice:a systematic review of health professionals' perceptions[J]. Implement Sci, 2006, 1:16. https://pubmed.ncbi.nlm.nih.gov/18752915/ [19] 明坚, 魏艳, 孙辉, 等.医患共同决策影响因素及对患者结果的影响[J].中国卫生质量管理, 2017, 24:90-93. http://www.cnki.com.cn/Article/CJFDTOTAL-WSJG201706035.htm [20] The World Bank. Physicians (per 1, 000 people)[EB/OL]. https: //data.worldbank.org/indicator/SH.MED.PHYS.ZS. [21] Fu Y, Schwebel DC, Hu G. Physicians' Workloads in China:1998-2016[J]. Int J Environ Res Public Health, 2018, 15:1649. https://www.mdpi.com/1660-4601/15/8/1649/pdf [22] Wu D, Lam TP, Lam KF, et al. Public views towards community health and hospital-based outpatient services and their utilisation in Zhejiang, China:a mixed methods study[J]. BMJ Open, 2017, 7:e017611. https://www.ncbi.nlm.nih.gov/pubmed/29101139 [23] Ousseine YM, Durand MA, Bouhnik AD, et al. Multiple health literacy dimensions are associated with physicians' efforts to achieve shared decision-making[J]. Patient Educ Couns, 2019, 102:1949-1956. [24] 刘树奎.乳腺癌诊疗过程中医患共同决策的价值[J].医学与社会, 2019, 32:61-63. http://www.cnki.com.cn/Article/CJFDTotal-YXSH201908015.htm [25] 徐梦阳, 张莉, 陈亚伟, 等.医生对医患共同决策选择倾向性研究[J].医学与哲学, 2019, 40:21-24. http://www.cnki.com.cn/Article/CJFDTotal-YXZX201906005.htm [26] 姜能志, 李长江, 孙琳, 等.基于共情心理的医学生医患沟通教育模式的构建[J].中国高等医学教育, 2018:17-18. http://www.cnki.com.cn/Article/CJFDTotal-ZOGU201807011.htm [27] 李强, 刘俊荣.甲状腺癌再手术医患共同决策的临床模式探讨[J].医学与哲学, 2018, 39:21-25. http://www.cnki.com.cn/Article/CJFDTotal-YXZX201810007.htm
点击查看大图
计量
- 文章访问数: 1093
- HTML全文浏览量: 209
- PDF下载量: 456
- 被引次数: 0