Nelson Wendy L, Han Paul K J, Fagerlin Angela, Stefanek Michael, Ubel Peter A
Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Med Decis Making. 2007 Sep-Oct;27(5):609-18. doi: 10.1177/0272989X07306780. Epub 2007 Sep 14.
Health decision aids are a potentially valuable adjunct to patient-physician communication and decision making. Although the overarching goal of decision aids--to help patients make informed, preference-sensitive choices--is widely accepted, experts do not agree on the means to achieve this end. In this article, the authors critically examine the theoretical basis and appropriateness of 2 widely accepted criteria used to evaluate decision aids: values clarification and reduction of decisional conflict. First, they argue that although clarifying values is central to decision making under uncertainty, it is not clear that decision aids--as they have been conceived and operationalized so far--can and should be used to achieve this goal. The pursuit of clarifying values, particularly values clarification exercises, raises a number of ethical, methodological, and conceptual issues, and the authors suggest research questions that should be addressed before values clarification is routinely endorsed. Second, the authors argue that the goal of reducing decisional conflict is conceptually untenable and propose that it be eliminated as an objective of decision aids.
健康决策辅助工具对于医患沟通和决策而言是一种潜在的宝贵辅助手段。尽管决策辅助工具的总体目标——帮助患者做出明智的、基于个人偏好的选择——已被广泛接受，但专家们对于实现这一目标的方式并未达成共识。在本文中，作者批判性地审视了用于评估决策辅助工具的两个被广泛接受的标准的理论基础和适用性：价值观澄清和减少决策冲突。首先，他们认为，虽然在不确定性情况下澄清价值观是决策的核心，但目前尚不清楚就决策辅助工具的构思和实施方式而言，它们是否能够以及应该被用于实现这一目标。追求澄清价值观，尤其是价值观澄清练习，引发了一些伦理、方法和概念问题，作者提出了在常规认可价值观澄清之前应解决的研究问题。其次，作者认为减少决策冲突的目标在概念上是站不住脚的，并提议将其作为决策辅助工具的一个目标予以摒弃。
