Gomella L G, Albertsen P C, Benson M C, Forman J D, Soloway M S
Jefferson Medical College, and Department of Urologic Oncology, Kimmel Cancer Center, Philadelphia, PA 19107, USA.
Semin Urol Oncol. 2000 Aug;18(3):182-7.
Increased consumerism, patient empowerment, and autonomy are creating a health care revolution. In recent years, the public has become better informed and more sophisticated. An extraordinary amount of treatment advice from books, the media, and the Internet is available to patients today, although much of it is confusing or conflicting. Consequently, the traditional, paternalistic doctor-patient relationship is yielding to a more consumerist one. The new dynamic is based on a participatory ethic and a change in the balance of power. This shared decision-making creates a true partnership between professionals and patients, in which each contributes equally to decisions about treatment or care. Evidence suggests that in diseases such as prostate cancer, where there may be a number of appropriate treatment options for a particular patient, shared decision-making may lead to improved clinical and quality-of-life outcomes. This article explores the evolving relationship between the physician and patient, the pros and cons of shared decision-making, and the use of video technology in the clinical setting. The authors review the use of medical decision aids, including a video-based educational program called CHOICES, in the treatment of prostate cancer and other diseases.
消费主义的增强、患者赋权及自主权正在引发一场医疗保健革命。近年来，公众见闻更广且更为成熟。如今，患者可以从书籍、媒体和互联网获得大量的治疗建议，尽管其中很多令人困惑或相互矛盾。因此，传统的、家长式的医患关系正在让位于更具消费主义色彩的关系。这种新动态基于一种参与性伦理以及权力平衡的变化。这种共同决策在专业人员和患者之间建立了真正的伙伴关系，双方在治疗或护理决策中发挥同等作用。有证据表明，在前列腺癌等疾病中，对于特定患者可能存在多种合适的治疗选择，共同决策可能会改善临床和生活质量结果。本文探讨了医患关系的演变、共同决策的利弊以及视频技术在临床环境中的应用。作者回顾了医疗决策辅助工具的使用情况，包括一个名为“选择”（CHOICES）的基于视频的教育项目在前列腺癌及其他疾病治疗中的应用。
