Treatment decision aids: conceptual issues and future directions
Treatment decision aids: conceptual issues and future directions
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DOI：
10.1111/j.1369-7625.2005.00325.x
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发表时间：
2005-06-01
影响因子：
3.2
通讯作者：
O'Brien, MA
中科院分区：
文献类型：
--
作者：
Charles, C;Gafni, A;O'Brien, MA
背景在过去的10年里，治疗决策辅助工具的发展有了很大的增长。已经为这些工具确定了多个目标。然而，这些目标在概念层面上的理论基础和意义，辅助决策工具旨在实现这些目标的机制，以及辅助工具设计和相关价值澄清练习背后的价值假设，往往没有得到明确的阐述。在本文中，我们提出了一些想法，以帮助为决策辅助工具的未来发展和评估提供信息。结果我们建议：(I)使用任何决策辅助工具的适当性应在更广泛的决策接触的背景下进行评估；(Ii)目标设置活动推动测量活动，而不是反过来；(Iii)对概念层面的目标及其产生影响的机制的理由和意义进行清楚的思考和明确；(Iv)向患者传达决策辅助工具和相关的价值澄清练习背后的价值假设；(V)制定并用于对各种决策辅助工具进行分类的分类包括关于每种工具的价值假设的部分；(Vi)进一步辩论和讨论明确的价值澄清练习作为治疗辅助决策工具的组成部分或辅助工具的作用以及实施有效措施的可行性。结论需要就上述问题进行进一步的辩论和讨论。
Background In the last 10 years, there has been a major growth in the development of treatment decision aids. Multiple goals have been identified for these tools. However, the rationale for and meaning of these goals at the conceptual level, the mechanisms through which decision aids are intended to achieve these goals, and value assumptions underlying the design of aids and associated values clarification exercises have often not been made explicit.Objective In this paper, we present ideas to help inform the future development and evaluation of decision aids.Results We suggest, (i) that the appropriateness of using any decision aid be assessed within the context of the wider decision-making encounter within which it is embedded; (ii) that goal setting activities drive measurement activities and not the other way round; (iii) that the rationale for and meaning of goals at the conceptual level, and mechanisms through which they are intended to have an impact be clearly thought through and made explicit; (iv) that value assumptions underlying both decision aids and associated values clarification exercises be communicated to patients; (v) that taxonomies developed and used to classify various types of decision aids include a section on value assumptions underlying each tool; (vi) that further debate and discussion take place on the role of explicit values clarification exercises as a component of or adjunct to treatment decision aids and the feasibility of implementing valid measures.Conclusion Further debate and discussion is needed on the above issues.