Entwistle V A, Sowden A J, Watt I S
NHS Centre for Reviews and Dissemination, University of York, UK.
J Health Serv Res Policy. 1998 Apr;3(2):100-7. doi: 10.1177/135581969800300208.
Interventions to inform patients about health care options and to involve them in decisions about their care are now widely advocated. The question of which criteria should be used to judge the effectiveness of such interventions has, however, received little attention. The provision of research-based information about health care effectiveness to patients and the promotion of greater patient involvement in health care decision-making are likely to have a complex range of effects on: the information provided to patients; patients' acquisition of skills; patients' knowledge and emotions; how decisions are made; the quality of decisions; professional-patient relationships; the use of health care; the health of patients; satisfaction; and the organisation and cost of health services. Opinions about which effects are most important and how they should be measured and valued will be influenced by a variety of factors, including: the rationales and motives underlying interest in patient involvement in decision-making; the forms of patient involvement envisaged; and the types of interventions being considered. In the context of health care systems which aim primarily to improve health status and well-being, health outcomes should take priority over process variables such as decision-making behaviours and patients' knowledge.
如今，广泛提倡采取干预措施，让患者了解医疗保健选择并参与有关其治疗的决策。然而，关于应使用哪些标准来评判此类干预措施的有效性这一问题，却很少受到关注。向患者提供基于研究的医疗保健有效性信息以及促使患者更多地参与医疗保健决策，可能会对以下方面产生一系列复杂的影响：提供给患者的信息；患者技能的获得；患者的知识和情绪；决策方式；决策质量；医患关系；医疗保健的使用；患者的健康状况；满意度；以及卫生服务的组织和成本。关于哪些影响最为重要以及应如何衡量和评估这些影响的观点，将受到多种因素的影响，包括：患者参与决策背后的基本原理和动机；设想的患者参与形式；以及正在考虑的干预措施类型。在主要旨在改善健康状况和福祉的医疗保健系统背景下，健康结果应优先于诸如决策行为和患者知识等过程变量。
