Shared Decision-making in the Emergency Department: Respecting Patient Autonomy When Seconds Count
Shared Decision-making in the Emergency Department: Respecting Patient Autonomy When Seconds Count
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DOI：
10.1111/acem.12703
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发表时间：
2015-07-01
影响因子：
4.4
通讯作者：
Carpenter, Christopher R.
中科院分区：
文献类型：
--
作者：
Hess, Erik P.;Grudzen, Corita R.;Carpenter, Christopher R.
共享决策（SDM），一个合作的过程中，病人和提供者一起作出医疗保健决策，考虑到最好的科学证据，以及病人的价值观和偏好，越来越多地提倡作为最佳的方法来决策许多医疗保健决策。然而，急诊科（艾德）的快速节奏和经常混乱的环境是一个独特的临床环境，提供了许多实际和背景的挑战。尽管存在这些挑战，但在最近的一项调查中，急诊医生报告说，超过50%的患者有一种以上的合理管理选择，58%的患者采用SDM方法。SDM还被选为2016年学术急诊医学共识会议制定未来研究议程的主题，急诊科的共同决策：制定政策相关的以患者为中心的研究议程（）。在本文中，作者描述了SDM的概念模型，最初设想的查尔斯和加夫尼和突出方面的模式有关的实践，急诊医学。此外，通过使用从作者的临床实践的小插曲，SDM的适用性，以当代EM实践的说明和采取SDM方法的伦理和务实的影响进行了探讨。希望在2016年学术急诊医学共识会议之前阅读本文件，以促进会议上的小组讨论。
Shared decision-making (SDM), a collaborative process in which patients and providers make health care decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences, is being increasingly advocated as the optimal approach to decision-making for many health care decisions. The rapidly paced and often chaotic environment of the emergency department (ED), however, is a unique clinical setting that offers many practical and contextual challenges. Despite these challenges, in a recent survey emergency physicians reported there to be more than one reasonable management option for over 50% of their patients and that they take an SDM approach in 58% of such patients. SDM has also been selected as the topic on which to develop a future research agenda at the 2016 Academic Emergency Medicine consensus conference, Shared Decision-making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda (). In this paper the authors describe the conceptual model of SDM as originally conceived by Charles and Gafni and highlight aspects of the model relevant to the practice of emergency medicine. In addition, through the use of vignettes from the authors' clinical practices, the applicability of SDM to contemporary EM practice is illustrated and the ethical and pragmatic implications of taking an SDM approach are explored. It is hoped that this document will be read in advance of the 2016 Academic Emergency Medicine consensus conference, to facilitate group discussions at the conference.