A Learning Loop Model of Collaborative Decision-Making in Chronic Illness
A Learning Loop Model of Collaborative Decision-Making in Chronic Illness
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DOI：
10.1016/j.acap.2019.04.006
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发表时间：
2019-07-01
影响因子：
3.1
通讯作者：
Stange, Kurt C.
中科院分区：
文献类型：
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作者：
Ronis, Sarah D.;Kleinman, Lawrence C.;Stange, Kurt C.
共同决策是优质医疗保健的核心属性，在儿科实践中实施和评估具有挑战性。目前的共同决策模式是有限的，包括其纳入多个利益攸关方的能力;整合次紧急或次要决定的下游影响的能力;以及考虑到做出和颁布此类决定的背景的能力。基于组织心理学，认知科学，商业和医学的文献综述，我们提出了一个迭代决策模型的护理规划和确定目标在几个层次的影响力消除测量在未来的研究。我们的学习循环模型假定儿科患者，他们的父母和他们的临床医生之间的关系是慢性疾病背景下协作决策过程的核心。该模型结合了随着时间的推移，背景和发展能力的演变。它表明，“元学习”的经验和结果，从迭代决策是一个关键因素，可能会影响关系，从而继续参与合作的患者，他们的父母，和他们的临床医生。我们认为该模型的儿童有特殊的医疗保健需求，对他们来说，了解决策的持续迭代效应和临床医生的亲子动态可能是特别重要的影响结果。
Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician parent child dynamics are likely to be particularly important in influencing outcomes.