Shared Decision Making in the Safety Net: Where Do We Go from Here?
Shared Decision Making in the Safety Net: Where Do We Go from Here?
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DOI：
10.3122/jabfm.2014.02.130245
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发表时间：
2014-03-01
影响因子：
2.9
通讯作者：
Montori, Victor M.
中科院分区：
文献类型：
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作者：
Bouma, Angelique B.;Tiedje, Kristina;Montori, Victor M.
背景资料：共享决策（SDM）是临床医生和患者之间的交互过程，在此过程中，双方共享信息，共同商议并做出临床决策。为安全网患者提供服务的诊所面临特殊挑战，包括资源更少和更具挑战性的工作环境。SDM安全网institutions内的使用还没有得到很好的study.Methods：我们招募了一个方便的样本15个安全网初级保健临床医生（13名医生，2名执业护士）。每个人都回答了9项SDM问卷，并参加了半结构化访谈。从转录的访谈和问卷调查数据，我们确定了主题和建议，介绍SDM到一个安全网environment.Results：临床医生报告说，只有部分履行SDM的核心组成部分（共享信息，审议，决策）。大多数临床医生通过声明他们与患者“一起选择了一种治疗方案”（15例中有8例完全同意）表达了对SDM的兴趣，但只有少数（15例中有3例）与患者一起“彻底权衡了不同的治疗方案”。临床医生将这一差距归因于许多障碍，包括时间压力、压倒性的就诊内容、患者偏好和缺乏可用资源。所有的临床医生认为，缺乏时间，难以实践SDM.Conclusions：为了增加使用SDM的安全网，有效的SDM干预措施，设计为这个环境，团队护理，并在SDM患者的参与将需要进一步发展。未来的研究应侧重于使SDM适应安全网环境，并确定SDM是否可以减少卫生保健差距。
Background: Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied.Methods: We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment.Results: Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they "selected a treatment option together" with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) "thoroughly weighed the different treatment options" together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM.Conclusions: To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.