Shared decision making in clinical medicine: Past research and future directions
Shared decision making in clinical medicine: Past research and future directions
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DOI：
10.1016/s0749-3797(99)00097-5
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发表时间：
1999-11-01
影响因子：
5.5
通讯作者：
Kaplan, RM
中科院分区：
文献类型：
--
作者：
Frosch, DL;Kaplan, RM
共享医疗决策是患者和提供者考虑结果概率和患者偏好并基于相互协议达成医疗保健决策的过程。共享决策最好用于涉及医疗不确定性的问题。在这个过程中，提供者-患者二人组考虑治疗方案和后果，并探索治疗的预期益处和后果与患者对各种结果的偏好的匹配。本文回顾了文献共享医疗决策。考虑了几个问题。虽然有几项研究表明，患者不想参与决策，但这些研究通常未能将治疗技术方面的决定与结果偏好分开。有相当多的证据表明，患者希望就治疗的影响进行咨询。关于医生共同决策的可接受性的研究产生了不一致的结果。共同决策更容易被年轻和受过良好教育的患者接受。目前尚不清楚共享决策是否需要昂贵的视频演示，或者是否可以通过更简单的方法（如决策委员会）获得相同的结果。我们的结论是，共享医疗决策是医疗保健的一个重要发展。需要更多的研究来确定共同决策对患者满意度和健康结果的影响。此外，还需要进行更多的研究，以评估让患者参与自己的医疗保健决策的最有效方法。
Shared medical decision making is a process by which patients and providers consider outcome probabilities and patient preferences and reach a health care decision based on mutual agreement. Shared decision making is best used for problems involving medical uncertainty. During the process the provider-patient dyad considers treatment options and consequences and explores the fit of expected benefits and consequences of treatment with patient preferences for various outcomes. This paper reviews the literature on shared medical decision making. Several questions are considered. Although several studies suggest that patients do not want to be involved in decision making, these studies typically fail to separate decisions about technical aspects of treatment from preferences for outcomes. There is considerable evidence that patients want to be consulted about the impact of treatment. Studies on the acceptability of shared decision making for physicians have produced inconsistent results. Shared decision making is more acceptable to younger and better-educated patients. It remains unclear whether shared decision making requires expensive video presentations or whether the same results can be obtained with simpler methods, such as the decision board. We conclude that shared medical decision making is an important development in health care. More research is necessary to identify the effects of shared decision making on patient satisfaction and health outcomes. Further, more research is necessary in order to evaluate the most effective methods for engaging patients in decisions about their own health care.