Towards a feasible model for shared decision making: focus group study with general practice registrars
Towards a feasible model for shared decision making: focus group study with general practice registrars
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DOI：
10.1136/bmj.319.7212.753
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发表时间：
1999-09-18
影响因子：
--
通讯作者：
Grol, R
中科院分区：
文献类型：
--
作者：
Elwyn, G;Edwards, A;Grol, R
目的 通过模拟全科医生咨询的方式，探讨全科医师注册员对患者参与决策的看法，并评估使用共享决策模型的可行性。设计基于焦点小组访谈的定性研究。制定南威尔士全科医师职业培训计划。参与者 39 名全科医师注册员和 8 名课程组织者（作为观察员）参加了 4 次课程；每次有三名模拟患者参加。方法在介绍了共同决策的原则和建议阶段后，登记员使用口头、数字和图形数据格式与模拟患者进行了一系列有关治疗选择的咨询并进行了观察。每次咨询和内容分析后，通过焦点小组访谈来引发反应。结果 全科医师报告称，他们没有接受过让患者参与临床决策所需技能的培训。他们对“让患者参与决策”有各种各样的看法，从保护性家长作风（“医生最了解”），到开明的自我利益（减轻负担），再到与患者建立更加平等的关系的潜在回报。这项工作指出了该过程的三个背景先兆：可靠信息的可用性、决策过程的适当时机以及患者接受在自己的管理中发挥积极作用的准备结论共享决策需要共享医疗过程结果的不确定性，并涉及暴露数据通常不可用或未知的事实；这可能会引起患者和临床医生的焦虑。进一步患者参与的进展将取决于专业人员的技能和态度，这项工作展示了如果要朝这个方向取得进一步进展需要采取的步骤。
Objectives To explore the views of general practice registrars about involving patients in decisions and to assess the feasibility of using the shared decision making model by means of simulated general practice consultations.Design Qualitative study based on focus group interviews.Setting General practice vocational training schemes in south Wales.Participants 39 general practice registrars and eight course organisers (acting as observers) attended four sessions; three simulated patients attended each time.Method After an introduction to the principles and suggested stages of shared decision making the registrars conducted and observed a series of consultations about choices of treatment with simulated patients using verbal, numerical, and graphical data formats. Reactions were elicited by using focus group interviews after each consultation and content analysis undertaken.Results Registrars in general practice report not being trained in the skills required to involve patients in clinical decisions. They had a wide range of opinions about "involving patients in decisions," ranging from protective paternalism ("doctor knows best"), through enlightened self interest (lightening the load), to the potential rewards of a more egalitarian relationship with patients. The work points to three contextual precursors for the process: the availability of reliable information, appropriate timing of the decision making process, and the readiness of patients to accept an active role in their own managementConclusions Sharing decisions entails sharing the uncertainties about the outcomes of medical processes and involves exposing the fact that data are often unavailable or not known; this can cause anxiety to both patient and clinician. Movement towards further patient involvement will depend on both the skills and the attitudes of professionals, and this work shows the steps that need to be taken if further progress is to be made in this direction.