Shared Decision-Making as the Future of Emergency Cardiology.
Shared Decision-Making as the Future of Emergency Cardiology.
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DOI：
10.1016/j.cjca.2017.09.014
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Hess EP
中科院分区：
文献类型：
--
作者：
Probst MA;Noseworthy PA;Brito JP;Hess EP
共同决策在急诊心血管护理中发挥着越来越大的作用。虽然在急诊科成功执行共享决策存在许多挑战，但有许多临床场景应该使用它。在本文中，我们探讨了以下紧急护理场景中的新研究和新兴决策辅助工具：1）低风险胸痛，2）新发房颤和3）中度风险晕厥。这些决策辅助工具旨在让患者参与并促进具体治疗和处置（入院与出院）决策的共同决策。然后，我们提供了一个3步，实用的方法来执行共享决策在急性护理环境中，广泛的利益相关者的输入和先前的概念工作的基础上。步骤1涉及简单地承认需要做出临床决策。第二步是在病人的价值观、偏好和环境的背景下，共同讨论工作诊断和护理选择。第三步也是最后一步，要求患者和提供者就进一步医疗护理的行动计划达成一致。在急诊心脏病学中实施共同决策有可能将临床实践的范式从家长制转变为互助制，并提高我们患者的护理质量和体验。
Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios where it should be used. In this paper, we explore new research and emerging decision aids in the following emergency care scenarios: 1) low-risk chest pain, 2) new-onset atrial fibrillation, and 3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit versus discharge) decisions. We then offer a 3-step, practical approach to performing shared decision-making in the acute care setting, based on broad stakeholder input and prior conceptual work. Step 1 involves simply acknowledging that a clinical decision needs to be made. Step 2 involves a shared discussion about the working diagnosis and the options for care in the context of the patient’s values, preferences, and circumstances. The third and final step requires the patient and provider to agree on a plan of action regarding further medical care. The implementation of shared decision-making in emergency cardiology has the potential to shift the paradigm of clinical practice from paternalism towards mutualism and improve the quality and experience of care for our patients.
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影响因子：
--
作者：
Graff, Louis G;Chern, Chii-Hwa;Radford, Martha
通讯作者：
Radford, Martha
影响因子：
1.8
作者：
Fuenzalida, Carolina;Hernandez, Gritzel;Coll-Vinent, Blanca
通讯作者：
Coll-Vinent, Blanca
影响因子：
6.2
作者：
Atzema, Clare L.;Austin, Peter C.;Dorian, Paul
通讯作者：
Dorian, Paul
影响因子：
6.3
作者：
Eckman MH;Lip GY;Wise RE;Speer B;Sullivan M;Walker N;Kissela B;Flaherty ML;Kleindorfer D;Baker P;Ireton R;Hoskins D;Harnett BM;Aguilar C;Leonard A;Arduser L;Steen D;Costea A;Kues J
通讯作者：
Kues J
影响因子：
4.4
作者：
Hess, Erik P.;Grudzen, Corita R.;Carpenter, Christopher R.
通讯作者：
Carpenter, Christopher R.