Involvement in treatment decision-making: Its meaning to people with diabetes and implications for conceptualisation
Involvement in treatment decision-making: Its meaning to people with diabetes and implications for conceptualisation
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DOI：
10.1016/j.socscimed.2007.09.001
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发表时间：
2008-01-01
影响因子：
5.4
通讯作者：
Francis, Jillian J.
中科院分区：
文献类型：
--
作者：
Entwistle, Vikki;Prior, Maria;Francis, Jillian J.
患者参与决策被广泛认为是高质量医疗保健的一个重要特征。决策者特别关注确保患者了解并能够在相关治疗方案之间做出选择，但尚不清楚患者如何理解和重视参与。我们调查了糖尿病患者参与治疗决策的意义。我们对18名年龄在20至79岁之间患有I型或2型糖尿病的患者进行了半结构化访谈，这些患者来自苏格兰格兰扁区4家多医生门诊诊所。我们使用了几种策略来探索他们对参与的理解，包括讨论他们如何回应出现在用于监测英格兰医疗保健质量的全国患者调查中有关参与治疗决策的问题。参与者将参与决策与医疗保健服务的风气和感觉（欢迎、尊重、促进患者贡献和不评判）相关的一些特征联系起来；健康问题的沟通（医生关心病人的意见，病人的感受被倾听；医生根据自己的专业知识和病人的理解给出清晰的解释）；以及关于治疗的沟通（从业人员以患者理解的方式解释治疗原理，并使患者感到他们有发言权）。我们的研究结果对实际尝试让患者参与他们的护理决策以及患者参与的概念化和评估具有启示意义。他们建议，渴望促进患者参与的从业人员应该注意他们在咨询中培养的精神，他们讨论问题的方式，以及提供有关治疗方案和患者影响决策的范围的信息。需要开发患者参与决策的模型和分类，以适应问题解决阶段和参与的关系和主观维度。(c) 2007 Elsevier Ltd.版权所有。
Patient involvement in decision-making is widely regarded as an important feature of good-quality healthcare. Policymakers have been particularly concerned to ensure that patients are informed about and enabled to choose between relevant treatment options, but it is not clear how patients understand and value involvement.We investigated the meaning of involvement in treatment decision-making for people with diabetes. We conducted semistructured interviews with 18 people aged between 20 and 79 who had type I or type 2 diabetes selected from 4 multipractitioner outpatient clinics in the Grampian area of Scotland. We used several strategies to probe their understandings of involvement, including a discussion of how they would respond to a question about involvement in treatment decisions that appears on the National Patient Survey used to monitor the quality of healthcare in England.Participants associated involvement in decision-making with a number of features relating to the ethos and feel of healthcare encounters (welcoming; respectful; facilitative of patients' contributions; and non-judgemental); communication about health problems (practitioners attending to patients' views and patients feeling listened to; practitioners giving clear explanations based on their professional knowledge and patients understanding these); and communication about treatments (practitioners explaining treatment rationales in ways that patients understand and enabling patients to feel they have a say).Our findings have implications for practical attempts to involve patients in decisions about their care and for the conceptualisation and assessment of patient involvement. They suggest that practitioners who aspire to facilitate patient involvement should attend to the ethos they foster in consultations and the way they discuss problems as well as to the provision of information about treatment options and the scope patients have to influence decisions. Models and taxonomies of patient involvement in decision-making need to be developed to accommodate both problem-solving phases and the relational and subjective dimensions of involvement. (c) 2007 Elsevier Ltd. All rights reserved.