Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, CB 8100, St. Louis, Missouri 63110, USA.
Oncologist. 2012;17(1):91-100. doi: 10.1634/theoncologist.2011-0261. Epub 2012 Jan 10.
There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference-sensitive decisions by incorporating patient preferences into decision discussions.
This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient-centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference-sensitive decisions in which SDM can enhance the clinical encounter.
Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision-making process.
Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions.
患者、政策制定者和临床医生越来越关注共同决策（SDM），将其作为一种让患者参与健康决策并将证据转化为临床实践的手段。然而，很少有临床医生觉得自己经过了充分的培训，可以在实践中实施 SDM，许多患者报告说，他们在癌症护理决策中的参与度低于自己的期望。SDM 可以通过将患者的偏好纳入决策讨论，从而有助于解决许多偏好敏感决策中报告的广泛实践差异。
本文提供了一种将 SDM 纳入常规肿瘤学实践的观点，以促进以患者为中心的沟通并促进有效的治疗决策。由于在大量偏好敏感的决策中，SDM 可以增强临床接触，肿瘤学实践具有独特的优势来引领 SDM 的采用。
临床医生可以通过以下方式促进癌症决策：（a）确定 SDM 至关重要的情况；（b）向患者承认决策；（c）描述可用选项，包括与选项相关的风险、益处和不确定性；（d）引出患者的偏好；（e）就决策过程的下一步计划达成一致。
鉴于最近在将 SDM 纳入政策并将证据转化为常规临床实践方面的举措，肿瘤学家可能会继续扩大 SDM 的使用，并将不得不面对将 SDM 纳入其临床工作流程的挑战。需要进一步研究探索克服这些挑战的方法，以便将高质量的证据和患者的偏好都恰当地转化并纳入肿瘤学护理决策中。
