A patient in the clinic; a person in the world. Why shared decision making needs to center on the person rather than the medical encounter
A patient in the clinic; a person in the world. Why shared decision making needs to center on the person rather than the medical encounter
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DOI：
10.1016/j.pec.2016.10.016
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发表时间：
2017-03-01
影响因子：
3.5
通讯作者：
Morris, Megan A.
中科院分区：
文献类型：
--
作者：
Clayman, Marla L.;Gulbrandsen, Pal;Morris, Megan A.
对共同决策的兴趣有所增加，并得到广泛推广。然而，从实践和测量的角度来看，SDM的起源作为一个病人自主权的产物，导致狭隘的概念化和操作化的决策。对个体患者自主性的狭隘关注主要在四个方面失败：1）排除决策伙伴在决策中的角色，行动和影响的几个方面; 2）只关注医疗遭遇; 3）忽视患者可以访问的信息环境; 4）将每次遭遇视为独立于所有其他遭遇。除了创建一个研究议程，可以回答有关如何做出决策及其后果的重要悬而未决的问题外，将SDM重新定义为以人为中心，而不是以医疗接触为中心，有可能改变患者和家庭的疾病经历以及临床医生如何在他们的工作中找到意义。(C)2016爱思唯尔爱尔兰有限公司版权所有。
Interest in shared decision making (SDM) has increased and become widely promoted. However, from both practical and measurement perspectives, SDM's origin as an outgrowth of patient autonomy has resulted in narrowly conceptualizing and operationalizing decision making. The narrow focus on individual patient autonomy fails in four main ways: 1) excluding several facets of the roles, actions, and influences of decision partners in decision making; 2) focusing solely on the medical encounter; 3) ignoring the informational environment to which patients have access; and 4) treating each encounter as independent of all others. In addition to creating a research agenda that could answer important outstanding questions about how decisions are made and the consequences thereof, reconceiving SDM as centered on the person rather than the medical encounter has the potential to transform how illness is experienced by patients and families and how clinicians find meaning in their work. (C) 2016 Elsevier Ireland Ltd. All rights reserved.