Shared decision-making as an existential journey: Aiming for restored autonomous capacity
Shared decision-making as an existential journey: Aiming for restored autonomous capacity
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DOI：
10.1016/j.pec.2016.07.014
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发表时间：
2016-09-01
影响因子：
3.5
通讯作者：
Elwyn, Glyn
中科院分区：
文献类型：
--
作者：
Gulbrandsen, Pal;Clayman, Marla L.;Elwyn, Glyn
目的：我们描述了疾病代表存在问题的不同方式，以及它对共同决策的影响。方法：我们探索医疗遭遇中共同决策的核心概念（不确定性、脆弱性、依赖性、自主性、权力、信任、责任），以解释和解释现有结果，并为未来的研究提出对共同决策的更广泛理解。结果：存在的方面包括身体、社会、心理和精神。疾病造成的不确定性和脆弱性暴露了这些方面，并可能导致对提供者的依赖，这强调了自主权不仅是一种个人地位，而且是一种不同的能力和自然关系。在共同决策中，权力和信任是可能增加或减少患者依赖的重要因素，特别是当信息过载可能增加不确定性时。结论：患者的基本不确定性、脆弱性和权力缺失使共同决策具有更深层次的存在意义，需要更多地关注护理的情感和关系维度。因此，我们建议共同决策的目标应该是恢复病人的自主能力。实践影响：在进行共同决策时，需要注意包括存在方面；告知和探索偏好是不够的。2016爱思唯尔爱尔兰有限公司版权所有。
Objective: We describe the different ways in which illness represents an existential problem, and its implications for shared decision-making.Methods: We explore core concepts of shared decision-making in medical encounters (uncertainty, vulnerability, dependency, autonomy, power, trust, responsibility) to interpret and explain existing results and propose a broader understanding of shared-decision making for future studies.Results: Existential aspects of being are physical, social, psychological, and spiritual. Uncertainty and vulnerability caused by illness expose these aspects and may lead to dependency on the provider, which underscores that autonomy is not just an individual status, but also a varying capacity, relational of nature. In shared decision-making, power and trust are important factors that may increase as well as decrease the patient's dependency, particularly as information overload may increase uncertainty.Conclusion: The fundamental uncertainty, state of vulnerability, and lack of power of the ill patient, imbue shared decision-making with a deeper existential significance and call for greater attention to the emotional and relational dimensions of care. Hence, we propose that the aim of shared decision-making should be restoration of the patient's autonomous capacity.Practice implications: In doing shared decision-making, care is needed to encompass existential aspects; informing and exploring preferences is not enough. (C) 2016 Elsevier Ireland Ltd. All rights reserved.