Beyond rationality: Expanding the practice of shared decision making in modern medicine.
Beyond rationality: Expanding the practice of shared decision making in modern medicine.
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DOI：
10.1016/j.socscimed.2021.113900
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Siminoff LA
中科院分区：
文献类型：
--
作者：
Thomas EC;Bass SB;Siminoff LA
当代医疗保健领域按照医疗决策的自主模式运作。该模型规定患者有权对其护理做出知情选择。共享决策 (SDM) 已成为临床医生和患者在护理规划和实施中协作的主要方法。这种方法在很大程度上依赖于规范（理性）决策过程，并且经常忽略源自个人、社会和环境因素的描述性影响，并解释现实世界中通常如何做出决策。对描述性决策缺乏关注在很多方面限制了 SDM。提出了一种扩大 SDM 实践的多层次方法，包括根据患者的社会、文化和环境背景定制决策；战略性地使用关系元素作为 SDM 流程的一部分；修改激励模型，以促进更多地关注对决策的描述性影响。这些修改预计将使 SDM 以及患者护理变得更加包容、有效并为不同的患者所接受。
The contemporary healthcare field operates according to an autonomy model of medical decision-making. This model stipulates that patients have the right to make informed choices about their care. Shared decision making (SDM) has arisen as the dominant approach for clinicians and patients to collaborate in care planning and implementation. This approach relies heavily on normative (rational) decision-making processes, and often leaves out descriptive influences that stem from personal, social, and environmental factors and explain how decisions are typically made in the real world. The lack of attention to descriptive decision-making limits SDM in many ways. A multi-level approach to expanding the practice of SDM is proposed, including tailoring the decision encounter based on patients’ social, cultural, and environmental context; using relational elements strategically as part of the SDM process; and modifying incentive models to promote greater attention to descriptive impacts on decision-making. These modifications are expected to make SDM, and thus patient care, more inclusive, effective, and acceptable to diverse patients.
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