Simmons Magenta, Hetrick Sarah, Jorm Anthony
Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.
Australas Psychiatry. 2010 Oct;18(5):394-7. doi: 10.3109/10398562.2010.499944.
Patient preference and involvement are two important aspects for many psychiatric treatment decisions. Shared decision-making (SDM) has been proposed as the optimal model to include patient preferences and involve patients in such decisions. Decision-making tools called decision aids (DA) are the most common application of SDM. DAs have been demonstrated to increase patients' knowledge, reduce decisional conflict, and reduce the proportion of patients who are passive in the decision-making process or remain undecided. Unfortunately, there are few DAs available for treatment decisions for psychiatric disorders and implementing SDM can be a challenge for mental health professionals. There are also issues unique to psychiatry related to the development and implementation of DAs that need consideration. Despite this, mental health professionals can and do still employ SDM techniques. This article offers an overview of the skills required to implement a SDM model and the resources currently available.
The core features of SDM are advocated for in clinical guidelines, but more resources are needed to ensure these recommendations are implemented in practice. In particular, the benefits of freely available DAs developed according to international standards need to be assessed for suitability and effectiveness.
患者偏好和参与是许多精神科治疗决策的两个重要方面。共同决策（SDM）已被提议作为纳入患者偏好并让患者参与此类决策的最佳模式。称为决策辅助工具（DA）的决策工具是SDM最常见的应用。已证明DA可增加患者的知识、减少决策冲突，并减少在决策过程中被动或仍未做出决定的患者比例。不幸的是，针对精神障碍治疗决策的DA很少，并且对心理健康专业人员而言实施SDM可能是一项挑战。与DA的开发和实施相关的精神科特有问题也需要考虑。尽管如此，心理健康专业人员能够且确实仍在采用SDM技术。本文概述了实施SDM模式所需的技能以及当前可用的资源。
临床指南提倡SDM的核心特征，但需要更多资源以确保这些建议在实践中得到实施。特别是，需要评估根据国际标准开发的免费DA的适用性和有效性。
