Shared decision making: trade-offs between narrower and broader conceptions
Shared decision making: trade-offs between narrower and broader conceptions
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DOI：
10.1111/j.1369-7625.2011.00694.x
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发表时间：
2011-06-01
影响因子：
3.2
通讯作者：
Entwistle, Vikki A.
中科院分区：
文献类型：
--
作者：
Cribb, Alan;Entwistle, Vikki A.
共同的决策方法，通过认识到卫生专业人员和患者的自主性和责任，旨在在“家长式”和“消费主义”的临床决策模式之间找到一条伦理的“中间路线”。人们对共同决策有不同的理解。在本文中，我们区分了狭义和广义的共享决策概念，并探讨了它们的相对优势和劣势。在论文的第一部分，我们构建了共享决策的一个原型狭义概念的概述(这个概念不符合任何特定的已发表模型，但反映了各种模型的特征)。我们指出了这样一个概念的缺点，并强调了如果要实现共享决策的伦理(和工具)目标，就需要拓宽我们对共享决策的思考。在论文的第二部分，我们通过考虑健康专业人员与患者之间的关系与常见的开放式关系(例如友谊)之间的类比，承认并探索在更广泛的共享决策概念下运作的优势和劣势。我们的结论是，狭隘的概念(可能保护患者免受不适当的家长式专业人员的伤害，但排除了重要的专业支持形式)和广义概念(使更多形式的专业支持合法，但可能需要并非所有卫生专业人员都拥有的技能或美德)之间的“权衡”表明，在原则上和实践中，需要找到认真对待患者自主和支持自主的专业干预的方法。
Shared decision-making approaches, by recognizing the autonomy and responsibility of both health professionals and patients, aim for an ethical 'middle way' between 'paternalistic' and 'consumerist' models of clinical decision making. Shared decision making has been understood in various ways. In this paper, we distinguish narrow and broader conceptions of shared decision making and explore their relative strengths and weaknesses. In the first part of the paper, we construct a summary characterization of an archetypal narrow conception of shared decision making (a conception that does not coincide with any specific published model but which reflects features of a variety of models). We show the shortcomings of such a conception and highlight the need to broaden out our thinking about shared decision making if the ethical (and instrumental) goals of shared decision making are to be realized. In the second part of the paper, we acknowledge and explore the advantages and disadvantages of operating with broader conceptions of shared decision making by considering the analogies between health professional-patient relationships and familiar examples of 'open-ended' relationships (e.g. friendships). We conclude by arguing that the illustrated 'trade-offs' between narrow conceptions (which may protect patients from inappropriately paternalistic professionals but preclude important forms of professional support) and broad conceptions (which render more forms of professional support legitimate but may require skills or virtues that not all health professionals possess) suggest the need to find ways, in principle and in practice, of taking seriously both patient autonomy and autonomy-supportive professional intervention.