Towle Angela, Godolphin William, Grams Garry, Lamarre Amanda
Department of Medicine & Undergraduate Dean's Office, Faculty of Medicine and Division of Health Care Communication, College of Health Disciplines, The University of British Columbia, Vancouver, BC, Canada.
Health Expect. 2006 Dec;9(4):321-32. doi: 10.1111/j.1369-7625.2006.00404.x.
To investigate the practice, experiences and views of motivated and trained family physicians as they attempt to implement informed and shared decision making (ISDM) in routine practice and to identify and understand the barriers they encounter.
Patient involvement in decision making about their health care has been the focus of much academic activity. Although significant conceptual and experimental work has been done, ISDM rarely occurs. Physician attitudes and lack of training are identified barriers.
Qualitative analysis of transcripts of consultations and key informant group interviews.
Six family physicians received training in the ISDM competencies. Audiotapes of office consultations were made before and after training. Transcripts of consultations were examined to identify behavioural markers associated with each competency and the range of expression of the competencies. The physicians attended group interviews at the end of the study to explore experiences of ISDM.
The physicians liked the ISDM model and thought that they should put it into practice. Evidence from transcripts indicated they were able to elicit concerns, ideas and expectations (although not about management) and agree an action plan. They did not elicit preferences for role or information. They sometimes offered choices. They had difficulty achieving full expression of any of the competencies and integrating ISDM into their script for the medical interview. The study also identified a variety of competency-specific barriers.
A major barrier to the practice of ISDM by motivated physicians appears to be the need to change well-established patterns of communication with patients.
调查积极主动且训练有素的家庭医生在日常实践中尝试实施知情与共同决策（ISDM）的做法、经验和观点，并识别和理解他们遇到的障碍。
患者参与自身医疗保健决策一直是众多学术活动的焦点。尽管已开展了大量概念性和实验性工作，但ISDM很少发生。医生的态度和缺乏培训被认为是障碍。
对会诊记录和关键信息提供者小组访谈记录进行定性分析。
六位家庭医生接受了ISDM能力培训。在培训前后录制了办公室会诊的录音带。对会诊记录进行检查，以识别与每种能力相关的行为标志以及能力的表达范围。在研究结束时，医生们参加了小组访谈，以探讨ISDM的经验。
医生们喜欢ISDM模式，并认为他们应该将其付诸实践。记录中的证据表明，他们能够引出患者的担忧、想法和期望（尽管不是关于治疗管理方面的），并商定行动计划。他们没有引出患者对角色或信息的偏好。他们有时会提供选择。他们难以充分展现任何一种能力，也难以将ISDM融入他们的医学问诊流程中。该研究还识别出了各种特定于能力的障碍。
积极主动的医生实施ISDM的一个主要障碍似乎是需要改变与患者既定的沟通模式。
