When Shared Decision Making Fails: Decisional Regret in Kidney Disease.
When Shared Decision Making Fails: Decisional Regret in Kidney Disease.
复制标题
当共同决策失败时：肾脏疾病中的决策遗憾。
DOI：
10.1016/j.xkme.2023.100789
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发表时间：
2024
期刊：
影响因子：
3.9
通讯作者：
Nair,Devika
中科院分区：
文献类型：
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作者：
Nair,Devika
当临床医生向患者提供有关最佳可用治疗证据的信息时，就会出现医疗保健方面的共同决策；支持患者考虑治疗方案；并与患者合作，做出符合其目标和价值观的明智选择。 1 根据决策理论，当一个人相信如果做出替代决策会取得更好的结果时，决策后悔就会发生。 2 当关于最佳行动方案的潜在有用信息在事后到达时，或者可能根本没有到达时，后悔就会增加。从本质上讲，决策后悔是患者在共同决策失败时可能会经历的事情。共同决策的重要性在肾病学中最常在开始透析的背景下被描述。最近，与透析相关的决策后悔已成为共同决策失败的潜在后果，也是学术研究的焦点。 3-5 在本期《肾脏医学》中，Pawar 等人（Pawar A、Thorsteindotir B、Whitman S 等人。围绕透析启动的决策后悔：比较分析。Kidney Med. 2023，出版中）应用独特的研究设计来进一步扩展我们对透析决策后悔的了解。 Pawar 等人采用顺序、解释性混合方法（定性和定量）设计，深入探讨了在一个学术医疗中心接受血液透析或腹膜透析的参与者做出决定后悔的原因。在该研究的初始定量阶段，使用经过验证的决策遗憾衡量标准对 78 名参与者进行了调查。这一步骤为研究随后的定性阶段中进行的有目的抽样提供了信息，在此期间，从报告决策后悔程度最高和最低的参与者中选出的 21 名参与者接受了采访。为了综合和报告参与者访谈的主题和副主题，作者应用了扎根理论，这是一种定性数据分析方法，通过该方法从数据中归纳得出理论见解。 6 报告决策后悔程度较低的参与者普遍报告了更健康的应对策略，包括积极的重构、接受、目标设定和培养健康的分心。最重要的是，这些人通过透析可以继续享受愉快的生活活动和支持性关系。那些表示更后悔做出决定的参与者强烈强调，由于缺乏与以下方面相关的知识，他们感到准备不足：
Shared decision making in health care occurs when clinicians provide patients with information on the best available treatment evidence; support patients in their deliberation of treatment options; and partner with patients to make an informed choice that aligns with their goals and values. 1 According to decision theory, decisional regret occurs when an individual believes that a better outcome would have been achieved had an alternate decision been made. 2 Regret increases when potentially useful information about the best course of action arrives after the fact, or perhaps never at all. In essence, decisional regret is what patients may experience when shared decision making fails.The importance of shared decision making has most frequently been described in nephrology in the context of beginning dialysis. More recently, decisional regret related to dialysis has emerged as a potential consequence of failed shared decision making and a focus of scholarly inquiry on its own. 3-5 In this issue of Kidney Medicine, Pawar et al (Pawar A, Thorsteindotir B, Whitman S, et al. Decisional regret surrounding dialysis initiation: a comparative analysis. Kidney Med. 2023, in press) apply a unique study design to further expand on our knowledge of decisional regret in dialysis. Using a sequential, explanatory mixed-methods (qualitative and quantitative) design, Pawar et al deeply explore causes of decisional regret among participants receiving hemodialysis or peritoneal dialysis at one academic medical center. In the study’s initial, quantitative phase, 78 participants were surveyed using a validated measure of decisional regret. This step informed the purposive sampling that occurred during the study’s subsequent qualitative phase, during which 21 participants, selected from those who reported the highest and lowest levels of decisional regret, were interviewed. To synthesize and report themes and subthemes from participant interviews, the authors applied grounded theory, a qualitative data analysis method by which theoretical insights are inductively derived from the data. 6 Participants reporting lower decisional regret generally reported healthier coping strategies, including positive reframing, acceptance, goal setting, and cultivating healthy distractions. Most importantly, these were individuals for whom dialysis allowed the continued presence of pleasurable life activities and supportive relationships. Those participants who reported higher decisional regret strongly emphasized feeling underprepared because of a lack of knowledge related to