Manufactured but not imported: new directions for research in shared decision making support and skills
Manufactured but not imported: new directions for research in shared decision making support and skills
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DOI：
10.1016/s0738-3991(03)00077-6
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发表时间：
2003-05-01
影响因子：
3.5
通讯作者：
Elwyn, G
中科院分区：
文献类型：
--
作者：
Edwards, A;Evans, R;Elwyn, G
关于共同决策的重大概念性工作已经发生，但在常规临床实践中实现这一目标仍然存在重大挑战。本文概述了到目前为止已确定的可能促进共同决策制定的研究，以及为实现持续进展所需的进一步研究。仍然需要更多地了解决策模式以及在实践中确定这些模式的手段。具体说明消费者的能力、开发评估这些能力的工具以及加强这些能力的干预措施也可能很重要。澄清所有这些方面可能使负责培训专业人员的人能够改进专业发展方案的内容。在风险很高的癌症治疗领域，这一点可能尤其重要--患者通常希望获得更多信息，但他们参与决策的愿望更具变数。无论这种平衡是对还是错，其后果都是重大的，既有得也有失。继续开发和评估使用交互技术的决策辅助工具和决策探索者，对于确定如何在消费者参与的情况下取得进展也将是重要的。如果我们能够吸取这些教训，那么更广泛地实施共享决策或消费者参与可能会变得更近。(C)2003爱思唯尔爱尔兰科学有限公司。保留所有权利。
Significant conceptual work on shared decision making has taken place but there are still significant challenges in achieving it in routine clinical practice. This paper outlines what research has identified to date that may promote shared decision making, and the further research that is required to enable continuing progress. Greater understanding of the models of decision making and instruments to identify them in practice are still required. Specifying consumer competences, developing instruments to assess these and interventions to enhance them may also be important. Clarifying all these aspects may enable those charged with training professionals to improve the content of professional development programmes. This may be particularly important in the field of cancer treatments where the stakes are high-patients usually desire much information but their desire for involvement in decision making is more variable. The consequences of getting this balance right or wrong are significant with much to be gained or lost. Continued development and evaluation of decision aids and decision explorers that use interactive technology will also be important in identifying how to progress with consumer involvement. If we can learn these lessons, then wider implementation of shared decision making or consumer involvement may become a nearer prospect. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.