Ford Sarah, Schofield Theo, Hope Tony
The Ethox Centre, Institute of Health Sciences, University of Oxford, Old Road, Headington, OX3 7LF, Oxford, UK.
Soc Sci Med. 2003 Feb;56(3):589-602. doi: 10.1016/s0277-9536(02)00056-4.
The evidence-based patient choice (EBPC) approach is one of a number of newly emerging templates for medical encounters that advocate evidence-informed choice and shared decision-making. These models emphasise respect for patient preferences for involvement in health care decisions and advocate the sharing of good quality evidence-based information. In the medical consultation EBPC involves providing patients with evidence-based information in a way that facilitates their ability to make choices or decisions about their health care. Whereas the key principles of shared decision-making have been conceptualised, so far, no qualitative investigations have been undertaken to establish the key components of an EBPC consultation. Therefore, a series of semi-structured interviews were carried out with key informants to identify the elements and skills required for a successful EBPC consultation to occur. The interviews were conducted with purposively selected UK general practitioners (n=11), hospital doctors (n=10), practice nurses (n=5), academics (n=11) and lay people (n=8). Qualitative analysis of participants' responses was conducted using the constant comparative method. Six main themes emerged from the data, these were research evidence/medical information, the doctor-patient relationship, patient perspectives, decision-making processes, time issues and establishing the patient's problem. All respondents placed importance on doctors and patients being well informed and appraised of the latest available medical evidence. There was a general view that evidence-based information regarding diagnosis and treatment options should be shared with patients during a consultation. However, there were no suggestions as to how this might be achieved in practice. Participants' opinions relating to which model of decision-making should be adopted ranged from favouring an informed choice model, to the view that decision-making should be shared equally. Similarly, there was no clear view on how much guidance a doctor should offer a patient during decision-making concerning the most appropriate treatment option for that patient.
循证患者选择（EBPC）方法是众多新出现的医疗问诊模板之一，这些模板提倡基于证据的选择和共同决策。这些模式强调尊重患者参与医疗决策的偏好，并主张分享高质量的循证信息。在医疗咨询中，EBPC包括以一种有助于患者对其医疗保健做出选择或决策的方式，向患者提供循证信息。虽然共同决策的关键原则已被概念化，但到目前为止，尚未进行定性调查来确定EBPC咨询的关键组成部分。因此，对关键信息提供者进行了一系列半结构化访谈，以确定成功进行EBPC咨询所需的要素和技能。访谈对象包括有目的地挑选出的英国全科医生（n = 11）、医院医生（n = 10）、执业护士（n = 5）、学者（n = 11）和普通民众（n = 8）。使用持续比较法对参与者的回答进行了定性分析。数据中出现了六个主要主题，分别是研究证据/医学信息、医患关系、患者观点、决策过程、时间问题和确定患者问题。所有受访者都强调医生和患者应充分了解并知悉最新的可用医学证据。普遍认为，在咨询过程中应与患者分享有关诊断和治疗选择的循证信息。然而，对于在实践中如何做到这一点，没有提出任何建议。参与者对于应采用哪种决策模式的意见不一，从倾向于知情选择模式到认为决策应平等分担的观点都有。同样，对于医生在为患者决策最合适的治疗方案时应给予多少指导，也没有明确的看法。
