Shared decision making in patients with diabetes mellitus
Shared decision making in patients with diabetes mellitus
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DOI：
10.4067/s0034-98872017000500012
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发表时间：
2017-05-01
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影响因子：
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通讯作者：
Montori, Víctor M
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文献类型：
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作者：
Serrano, Valentina;Larrea-Mantilla, Laura;Montori, Víctor M
糖尿病患者常常有多种医疗问题，并承受着疾病和治疗带来的负担。医疗保健往往忽视患者的价值观、偏好和背景，导致治疗方法不适合患者不堪重负的生活。共享决策 (SDM) 的出现是为了回答“什么对患者最好？”这个问题。 SDM 促进患者和临床医生之间的移情对话，将现有的最佳证据与他们的价值观、偏好和背景相结合。我们讨论了针对糖尿病患者的三种 SDM 方法：一种侧重于共享信息，另一种侧重于做出选择，第三种侧重于帮助患者和临床医生讨论如何解决糖尿病及其合并症的生活问题。尽管美国和欧洲进行的研究证明了 SDM 的好处，但 SDM 的实施仍然是一个挑战。在拉丁美洲，医疗保健和社会经济条件使得 SDM 的实施更具挑战性。旨在应对这一挑战的研究是必要的。同时，临床医生可以通过共享基于证据的信息、在做出选择时表达患者的价值观和偏好、以及创建旨在根据患者的背景、梦想、目标和生活期望做出的决策的同理心对话来实践 SDM。
Patients with diabetes mellitus often have several medical problems and carry a burden imposed by their illness and treatment. Health care often ignores the values, preferences and context of patients, leading to treatments that do not fit into patients' overwhelmed lives. Shared Decision Making (SDM) emerges as a way to answer the question: "What's best for the patient?". SDM promotes an empathic conversation between patients and clinicians that integrates the best evidence available with their values, preferences and context. We discuss three SDM approaches for patients with diabetes: one focused on sharing information, another on making choices, and a third one on helping patients and clinicians to talk about how to address the problems of living with diabetes and its comorbidities. Despite the benefits demonstrated in studies conducted in the U.S. and Europe, the implementation of SDM continues to be a challenge. In Latin America, healthcare and socio-economic conditions render the implementation of SDM more challenging. Research aimed to respond to this challenge is necessary. Meanwhile, clinicians can practice SDM by sharing evidence-based information, giving voice to patients' values and preferences in making choices, and creating empathic conversations aimed at decisions aligned with patients' context, dreams, goals, and life expectations.