Implementing shared decision making in routine mental health care
Implementing shared decision making in routine mental health care
复制标题
DOI：
10.1002/wps.20412
复制
发表时间：
2017-06-01
期刊：
影响因子：
73.3
通讯作者：
Slade, Mike
中科院分区：
文献类型：
--
作者：
Slade, Mike
精神卫生保健中的共享决策 (SDM) 涉及临床医生和患者共同做出决策。 SDM 的关键要素已经确定，决策支持工具已经开发，SDM 已在政策层面的心理健康领域得到推荐。但实施仍然有限。为了支持 SDM，通常提出两个理由。临床理由是 SDM 可以改善结果，但现有的经验证据基础尚无定论。伦理上的理由是，SDM是一项权利，但临床医生需要在自主和正义的生物医学伦理原则与仁慈和非恶意之间取得平衡。有人认为，SDM 是“多价的”，这是一个社会学概念，它描述了不同利益相关者之间表面上但不深入一致的想法。在常规心理健康服务中实施 SDM 既是一个文化问题，也是一个技术问题。确定了三个挑战：创建广泛的高质量决策支持工具；将 SDM 与其他康复支持干预措施相结合；当患者形成公民的正常期望时，应对文化变化。确定了两种可以帮助心理健康系统应对这些文化变化的方法——社会营销和酒店业。
Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is "polyvalent", a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes - social marketing and the hospitality industry - are identified.