A three-talk model for shared decision making: multistage consultation process
A three-talk model for shared decision making: multistage consultation process
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DOI：
10.1136/bmj.j4891
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发表时间：
2017-11-06
影响因子：
105.7
通讯作者：
Van der Weijden, Trudy
中科院分区：
文献类型：
--
作者：
Elwyn, Glyn;Durand, Marie Anne;Van der Weijden, Trudy
修订现有的三谈模式，以学习如何实现共同决策，并与相关利益相关者协商，以更新和获得更广泛的参与。多阶段咨询过程。设置关键信息提供者组，利益群体，临床专业调查。参与者19名关键信息提供者，来自多个利益群体的153名成员回复，在经过三次迭代的扩展咨询后，我们通过对一个谈话类别进行修改来修改三谈话模型，增加了引出患者目标的需要，为每个谈话类别提供了一组明确的任务，并添加建议的脚本来说明每个步骤。提出了一个新的共享决策的三谈模型，基于“团队谈话”，“选项谈话”和“决策谈话”，描绘了一个合作和审议的过程。团队谈话强调需要在患者意识到选择时为患者提供支持，并将其目标作为指导决策过程的一种手段。选项对话是指使用风险沟通原则比较替代方案的任务。决策谈话是指在达成的决定，反映知情的喜好的病人，由经验和专业知识的卫生professionals.CONCLUSIONSThe修订后的三谈模式的共享决策描绘会话步骤，推出时提供支持的选项，其次是战略比较和讨论权衡，审议之前的基础上知情的喜好。
OBJECTIVESTo revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement.DESIGNMultistage consultation process.SETTINGKey informant group, communities of interest, and survey of clinical specialties.PARTICIPANTS19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties.RESULTSAfter extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals.CONCLUSIONSThe revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.