Generalized shared decision making approaches and patient problems. Adapting AHRQ's SHARE Approach for Purposeful SDM.
Generalized shared decision making approaches and patient problems. Adapting AHRQ's SHARE Approach for Purposeful SDM.
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DOI：
10.1016/j.pec.2020.06.022
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发表时间：
2020-10
影响因子：
3.5
通讯作者：
Bierman AS
中科院分区：
文献类型：
--
作者：
Hargraves IG;Fournier AK;Montori VM;Bierman AS
广义共享决策（SDM）描述了患者参与选择选项。然而，在许多情况下，患者和临床医生一起做出决定，而不是专注于在选项之间进行选择，例如，解决问题的透析和旅行时使用胰岛素。与临床医生认为SDM不适用于他们所面临的临床情况相关的吸收不良可能反映了广义SDM方法对患者问题的适应性不足。2019年发布的有目的的SDM模式确定了适用于不同类型SDM的问题。美国卫生保健研究和质量署开发了SHARE作为一种通用的SDM方法。我们试图使SHARE适应患者面临的不同问题，使用矩阵将SHARE步骤和有目的的SDM模式联系起来，并描述这些模式中SDM的一般概念和实践的变化。许多SHARE沟通行为适用于不同模式，尽管SDM术语和实践的含义（例如，患者作为问题解决者与专家参与）差异很大。SHARE的各个方面需要适应不同的患者问题。SDM在教育、实践和工具方面可以通过使广义SDM方法适应患者的问题来支持。
Generalized shared decision-making (SDM) describes the involvement of patients in choosing options. However, there are many situations in which patients and clinicians make decisions together that don’t focus on choosing between options, e.g. problem-solving dialysis and insulin use while traveling. Poor uptake associated with clinicians’ perception that SDM doesn’t apply to clinical situations they face may reflect the lack of adaptation of generalized SDM approaches to patients’ problems. The Purposeful SDM schema published in 2019 identifies problems for which different kinds of SDM are appropriate. The U.S. Agency for Healthcare Research and Quality developed SHARE as a generalized SDM approach. We sought to adapt SHARE to the different problems that patients face using a matrix to relate SHARE steps and Purposeful SDM modes and describe changes in generalized concepts and practices of SDM across these modes. Many SHARE communicative behaviors applied across modes, although the meaning of SDM terms and practices, e.g. patients involved as problem solvers versus experts, varied substantially. Aspects of SHARE require adaptation to different patient problems. SDM in education, practice, and tools may be supported by adapting generalized SDM approaches to patients’ problems.
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