Shared Mind: Communication, Decision Making, and Autonomy in Serious Illness
Shared Mind: Communication, Decision Making, and Autonomy in Serious Illness
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DOI：
10.1370/afm.1301
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发表时间：
2011-09-01
影响因子：
4.4
通讯作者：
Street, Richard L., Jr.
中科院分区：
文献类型：
--
作者：
Epstein, Ronald M.;Street, Richard L., Jr.
在严重疾病的情况下，个人通常依靠他人帮助他们思考和感受困难的决定。为了帮助我们理解个人为什么、何时以及如何让可信任的他人参与分享信息、审议和决策，我们提出了共享思维的概念——在共享思维方式中，新的想法和观点可以通过在2个或更多的人中分享思想、感受、感知、意义和意图而出现。我们在研究协作认知、协调和意义构建的基础上，考虑了共享思维如何在关系和组织中普遍表现出来。然后，我们探讨了如何通过沟通促进共享思想，在适当的时候，以及共享思想对决策和患者自主的影响。接下来，我们考虑一个连续的以病人为中心的方法，以病人-临床医生的互动。在连续体的一端，互动方法促进将患者作为一个人来了解，调整信息，构建偏好，达成共识，并促进关系自治。另一方面，交易型方法侧重于患者的知识、信息商品、协商、同意和个人自主权。最后，我们建议自主和决策不仅要考虑患者、家属和医疗团队成员的个人观点，还要考虑他们之间相互作用产生的观点。通过关注共享思维，临床医生可以观察到他们可以通过双向信息共享和参与共同审议来促进共享思维的方式。
In the context of serious illness, individuals usually rely on others to help them think and feel their way through difficult decisions. To help us to understand why, when, and how individuals involve trusted others in sharing information, deliberation, and decision making, we offer the concept of shared mind-ways in which new ideas and perspectives can emerge through the sharing of thoughts, feelings, perceptions, meanings, and intentions among 2 or more people. We consider how shared mind manifests in relationships and organizations in general, building on studies of collaborative cognition, attunement, and sensemaking. Then, we explore how shared mind might be promoted through communication, when appropriate, and the implications of shared mind for decision making and patient autonomy. Next, we consider a continuum of patient-centered approaches to patient-clinician interactions. At one end of the continuum, an interactional approach promotes knowing the patient as a person, tailoring information, constructing preferences, achieving consensus, and promoting relational autonomy. At the other end, a transactional approach focuses on knowledge about the patient, information-as-commodity, negotiation, consent, and individual autonomy. Finally, we propose that autonomy and decision making should consider not only the individual perspectives of patients, their families, and members of the health care team, but also the perspectives that emerge from the interactions among them. By drawing attention to shared mind, clinicians can observe in what ways they can promote it through bidirectional sharing of information and engaging in shared deliberation.