Patient Autonomy for the Management of Chronic Conditions: A Two-Component Re-Conceptualization
Patient Autonomy for the Management of Chronic Conditions: A Two-Component Re-Conceptualization
复制标题
DOI：
10.1080/15265160802654111
复制
发表时间：
2009-01-01
影响因子：
13.4
通讯作者：
McCullough, Laurence B.
中科院分区：
文献类型：
--
作者：
Naik, Aanand D.;Dyer, Carmel B.;McCullough, Laurence B.
患者自主性概念的临床应用集中在考虑和做出治疗决定的能力（决策自主性），而实际上排除了执行治疗计划的能力（执行自主性）。然而，在多种慢性疾病的背景下，自主性的单一组成部分概念是有问题的。当患者存在功能、教育和认知障碍，损害了他们计划、排序和执行与慢性护理相关任务的能力时，对复杂治疗的坚持通常会失败。本文的目的是呼吁一个两个组成部分的自主性重新概念化，并认为慢性病患者的临床评估能力应扩大到包括自主决策和自主执行商定的治疗计划。我们解释了自主权的概念应该如何扩展到包括决策和执行自主权，描述了自主权的两个组成部分的概念的生物心理社会相关性，并建议诊断和治疗策略，以支持执行自主权的赤字患者。
The clinical application of the concept of patient autonomy has centered on the ability to deliberate and make treatment decisions (decisional autonomy) to the virtual exclusion of the capacity to execute the treatment plan (executive autonomy). However, the one-component concept of autonomy is problematic in the context of multiple chronic conditions. Adherence to complex treatments commonly breaks down when patients have functional, educational, and cognitive barriers that impair their capacity to plan, sequence, and carry out tasks associated with chronic care. The purpose of this article is to call for a two-component re-conceptualization of autonomy and to argue that the clinical assessment of capacity for patients with chronic conditions should be expanded to include both autonomous decision-making and autonomous execution of the agreed-upon treatment plan. We explain how the concept of autonomy should be expanded to include both decisional and executive autonomy, describe the biopsychosocial correlates of the two-component concept of autonomy, and recommend diagnostic and treatment strategies to support patients with deficits in executive autonomy.