Development of a nursing model to assist Japanese patients and family with health care decision making

卫生保健伦理中的主导原则强调尊重患者的自主权。护士经历了一次家庭请求，要求不要将诊断和预后告知患者。健康成年人希望家人参与医疗决策，医生对生活方式的意见程度低于对检查和治疗方式的意见程度。对终末期治疗决策的个人意见和家庭对延长生命治疗的意见倾向于成年人。患者及其家人最希望的决策偏好是在与医生和家人协商后自行做出决定。然而，对于符合条件的患者的决策过程，他们的偏好是不同的。很少有成人/患者及其家庭成员的卫生保健决策意愿匹配。护士有必要对患者的决策能力和自主偏好进行评估，以替代家属的判断。护士在促进患者及其家人之间讨论偏好方面扮演着理想的角色。

The reigning principle in health care ethics has been emphasized respect for patient autonomy. Nurses experience a family request not to inform a patient of a diagnosis and prognosis. The healthy adults desire the involvement of their family in health care decision making, and that the extents of physician’s opinion for the life style are lower than those for examination and treatment style. The extents of own opinion for the treatment decision and of family’s opinion for the life-prolonging treatment in the terminal stage tend to be taken by the adults. The most common decision-making preference desired by patients and their families are to make their own decisions after consultation with the physician and the family. However, preferences regarding the decision making process for competent patients are diverse among them. Few pairs of the adults/patients and their family members matched on desire for making decision in health care. It is necessary for nurse to assess the competency for decision making and autonomy preference of a patient and substitute judgment by family. Nurses are in the ideal role to facilitate discussions of preferences between patients and their family members.