Deliberation before determination: the definition and evaluation of good decision making
Deliberation before determination: the definition and evaluation of good decision making
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DOI：
10.1111/j.1369-7625.2009.00572.x
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发表时间：
2010-06-01
影响因子：
3.2
通讯作者：
Miron-Shatz, Talya
中科院分区：
文献类型：
--
作者：
Elwyn, Glyn;Miron-Shatz, Talya
ObjectivesIn this article，we examined definitions of suggested approaches to measure the concept of good decisions，highlight the ways in which they converge，and explain why we have concerns about their emphasis on post-hoc estimations and post-decisionial outcomes，their prescriptive concept of knowledge，and their lack of distinction between the process of deliberation，在临床实践中，让患者参与决策任务一直是一种稳定的趋势，这是从家长式作风向知情选择概念转变的一部分。对医学中存在的不确定性的认识增加，这是由于证据基础薄弱以及个人层面结果的随机性造成的，这有助于将决策的责任从医生转移到患者身上。这导致越来越多地使用决策支持和沟通方法，最终目的是改善患者的决策。因此，兴趣已经发展在试图定义良好的决策和发展的测量approaches.MethodWe提出并反映是否可以判断决策好或不好，如果是这样，如何这种善良可能是evaluated.ResultsWe假设，决定不能衡量参考他们的结果，并提供了一种替代手段的评估，它强调的是深思熟虑的过程，而不是决策的最终结果。我们建议决策包括一个决策前的过程和行为的决定，并考虑如何这种模式的决策服务于开发一种新的方法来评估什么是一个良好的决策过程。我们继续提供一个替代方案，它解析成决策前的审议过程中，行为的决心和决策后的outcomes.DiscussionEvaluating审议过程中，我们建议，应包括一个主观的充分的知识，以及情感处理和情感预测的替代品。这应该成为良好的决心行动的基础。
ObjectivesIn this article, we examine definitions of suggested approaches to measure the concept of good decisions, highlight the ways in which they converge, and explain why we have concerns about their emphasis on post-hoc estimations and post-decisional outcomes, their prescriptive concept of knowledge, and their lack of distinction between the process of deliberation, and the act of decision determination.BackgroundThere has been a steady trend to involve patients in decision making tasks in clinical practice, part of a shift away from paternalism towards the concept of informed choice. An increased understanding of the uncertainties that exist in medicine, arising from a weak evidence base and, in addition, the stochastic nature of outcomes at the individual level, have contributed to shifting the responsibility for decision making from physicians to patients. This led to increasing use of decision support and communication methods, with the ultimate aim of improving decision making by patients. Interest has therefore developed in attempting to define good decision making and in the development of measurement approaches.MethodWe pose and reflect whether decisions can be judged good or not, and, if so, how this goodness might be evaluated.ResultsWe hypothesize that decisions cannot be measured by reference to their outcomes and offer an alternative means of assessment, which emphasizes the deliberation process rather than the decision's end results. We propose decision making comprises a pre-decisional process and an act of decision determination and consider how this model of decision making serves to develop a new approach to evaluating what constitutes a good decision making process. We proceed to offer an alternative, which parses decisions into the pre-decisional deliberation process, the act of determination and post-decisional outcomes.DiscussionEvaluating the deliberation process, we propose, should comprise of a subjective sufficiency of knowledge, as well as emotional processing and affective forecasting of the alternatives. This should form the basis for a good act of determination.