Confronting evidence: individualised care and the case for shared decision-making.
Confronting evidence: individualised care and the case for shared decision-making.
复制标题
面对证据：个性化护理和共同决策的案例。
作者：
P. Ryan;D. Vaughan
在许多临床情况下，存在不止一种临床上适当的干预策略。当这些涉及潜在利益和危害之间的主观权衡时，患者的偏好应该为决策提供信息。共享决策是一个协作过程，临床医生和患者在尊重患者个性化护理偏好的情况下协调最佳可用证据。在实践中，临床医生可能没有足够的能力参与这一过程。共同决策适用于许多情况，包括稳定型冠状动脉疾病，临终关怀和慢性病管理中的许多小决定。有证据表明，临床上更合适的护理模式，改善患者的理解和赋权感。许多试验报告说，保守治疗使大手术减少了20%，尽管对某些干预措施的需求趋于增加。国际证据对爱尔兰的普遍适用性尚不清楚。考虑到潜在的好处，有理由在爱尔兰实施和评价共同决策试点项目。
In many clinical scenarios there exists more than one clinically appropriate intervention strategy. When these involve subjective trade-offs between potential benefits and harms, patients' preferences should inform decision-making. Shared decision-making is a collaborative process, where clinician and patient reconcile the best available evidence with respect for patients' individualized care preferences. In practice, clinicians may be poorly equipped to participate in this process. Shared decision-making is applicable to many conditions including stable coronary artery disease, end-of-life care, and numerous small decisions in chronic disease management. There is evidence of more clinically appropriate care patterns, improved patient understanding and sense of empowerment. Many trials reported a 20% reduction in major surgery in favour of conservative treatment, although demand tends to increase for some interventions. The generalizability of international evidence to Ireland is unclear. Considering the potential benefits, there is a case for implementing and evaluating shared decision-making pilot projects in Ireland.