A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes
A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes
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DOI：
10.1111/j.1369-7625.2006.00359.x
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发表时间：
2006-03-01
影响因子：
3.2
通讯作者：
Charles, C
中科院分区：
文献类型：
--
作者：
Montori, VM;Gafni, A;Charles, C
在这篇文章中，我们讨论了Charles等人。适用于慢性病患者及其临床医生的共享治疗决策(STDM)方法。我们注意到不同类型的治疗决定(例如临终关怀、癌症的外科治疗)之间的差异，这些决定产生了针对急性护理条件的现有共享决策方法(包括Charles等人)。以及慢性病患者需要做出的治疗决定和持续不断的复诊。例如，与急性护理决定相比，慢性护理环境中的治疗决定更有可能要求患者在执行决定时发挥更积极的作用，并提供更长的机会窗口来做出决定，并在没有重大损失的情况下重新检查和逆转决定。后者可能需要最少的患者参与才能实现，通常是紧急的，并且可能是不可逆转的。鉴于这些差异，我们探讨了Charles等人的适用性。在慢性护理背景下的STDM模式，特别是严重依赖患者自我管理的慢性护理(例如糖尿病)。应用查尔斯等人的观点。在这种临床背景下，我们建议有必要强调患者-临床医生关系作为做出困难治疗选择的合作伙伴之一，并在共同决策方法中增加一个新的组成部分：需要在临床团队(不仅仅是临床医生)和患者之间建立持续的伙伴关系。在论文的最后部分，我们探讨了STDM在慢性护理提供方面可能存在的医疗制度障碍。在整个讨论过程中，我们确定了需要进一步研究的领域。
In this paper, we discuss the Charles et al. approach to shared treatment decision-making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of treatment decisions (e.g. end-of-life care, surgical treatment of cancer) that generated existing approaches of shared decision-making for acute care conditions (including the Charles et al. model) and the treatment decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, treatment decisions in the chronic care setting are more likely to require a more active patient role in carrying out the decision and to offer a longer window of opportunity to make decisions and to revisit and reverse them without important loss than acute care decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self-management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient-clinician relationship as one of partners in making difficult treatment choices and to add a new component to the shared decision-making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research.