Gwyn Richard, Elwyn Glyn, Edwards Adrian, Mooney Annabelle
Health Communication Research Centre, School of English, Communication and Philosophy, Cardiff University, Cardiff, UK.
Health Expect. 2003 Sep;6(3):242-54. doi: 10.1046/j.1369-6513.2003.00245.x.
Shared decision-making is increasingly advocated as a means of interacting with patients but there is also a widely accepted view that many factors will militate against this ideal. While some patients may not wish to take on the responsibility of decision-making, it is also evident that many find it difficult to assimilate probabilities about future events and overestimate the likelihood of some outcomes, especially when terms such as 'stroke', 'bleeding' and 'heart attack' are used in consultation and bring with them emotional connotations and reactions. Under such circumstances, should clinicians portray risks as best they can, in the hope that even a marginally improved understanding will be an improvement on unilateral professional decision-making? Or, conversely, should they 'guide' the decision process, acting in a way that is known as 'professional agency'? Developing some perspectives put forward in recent work by the authors and applying it to a distinct clinical context, this paper will provide (i) a discourse analytic exploration of a single extended example from clinical practice employing aspects of Bakhtin's theory of dialogism, and (ii) a discussion and summary of what we can learn from this analysis in the context of shared decision-making and risk communication.
共同决策作为一种与患者互动的方式越来越受到提倡，但也有一种广泛认可的观点认为，许多因素会不利于实现这一理想状态。虽然一些患者可能不希望承担决策责任，但同样明显的是，许多患者发现难以理解关于未来事件的概率，并且高估某些结果的可能性，尤其是在咨询中使用“中风”“出血”和“心脏病发作”等术语时，这些术语会带来情感内涵和反应。在这种情况下，临床医生是应该尽可能准确地描述风险，期望即使是稍有改善的理解也会比单方面的专业决策有所进步？还是相反，他们应该以被称为“专业代理”的方式“引导”决策过程？本文将借鉴作者近期工作中提出的一些观点并将其应用于一个独特的临床背景，（i）运用巴赫金对话主义理论的各个方面，对临床实践中的一个单一扩展实例进行话语分析探索，（ii）讨论并总结在共同决策和风险沟通的背景下我们可以从这一分析中学到什么。
