Wiley Janice, Westbrook Mary, Greenfield Jerry R, Day Richard O, Braithwaite Jeffrey
Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales.
Diabetes and Obesity Program, Garvan Institute of Medical Research ; Department of Endocrinology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia.
Patient Prefer Adherence. 2014 Apr 2;8:423-35. doi: 10.2147/PPA.S57707. eCollection 2014.
Shared decision-making (SDM) is at the core of patient-centered care. We examined whether young adults with type 1 diabetes perceived the clinician groups they consulted as practicing SDM.
In a web-based survey, 150 Australians aged 18-35 years and with type 1 diabetes rated seven aspects of SDM in their interactions with endocrinologists, diabetes educators, dieticians, and general practitioners. Additionally, 33 participants in seven focus groups discussed these aspects of SDM.
Of the 150 respondents, 90% consulted endocrinologists, 60% diabetes educators, 33% dieticians, and 37% general practitioners. The majority of participants rated all professions as oriented toward all aspects of SDM, but there were professional differences. These ranged from 94.4% to 82.2% for "My clinician enquires about how I manage my diabetes"; 93.4% to 82.2% for "My clinician listens to my opinion about my diabetes management"; 89.9% to 74.1% for "My clinician is supportive of my diabetes management"; 93.2% to 66.1% for "My clinician suggests ways in which I can improve my self-management"; 96.6% to 85.7% for "The advice of my clinician can be understood"; 98.9% to 82.2% for "The advice of my clinician can be trusted"; and 86.5% to 67.9% for "The advice of my clinician is consistent with other members of the diabetes team". Diabetes educators received the highest ratings on all aspects of SDM. The mean weighted average of agreement to SDM for all consultations was 84.3%. Focus group participants reported actively seeking clinicians who practiced SDM. A lack of SDM was frequently cited as a reason for discontinuing consultation. The dominant three themes in focus group discussions were whether clinicians acknowledged patients' expertise, encouraged patients' autonomy, and provided advice that patients could utilize to improve self-management.
The majority of clinicians engaged in SDM. Young adults with type 1 diabetes prefer such clinicians. They may fail to take up recommended health services when clinicians do not practice this component of patient-centered care. Such findings have implications for patient safety, improved health outcomes, and enhanced health service delivery.
共同决策（SDM）是患者为中心的医疗的核心。我们调查了1型糖尿病的年轻成年人是否认为他们咨询的临床医生群体在践行共同决策。
在一项基于网络的调查中，150名年龄在18 - 35岁且患有1型糖尿病的澳大利亚人对他们与内分泌科医生、糖尿病教育者、营养师和全科医生互动中共同决策的七个方面进行了评分。此外，七个焦点小组中的33名参与者讨论了共同决策的这些方面。
在150名受访者中，90%咨询过内分泌科医生，60%咨询过糖尿病教育者，33%咨询过营养师，37%咨询过全科医生。大多数参与者对所有职业在共同决策的各个方面的评分都是倾向积极的，但存在专业差异。“我的临床医生询问我如何管理糖尿病”这一项的评分从94.4%到82.2%不等；“我的临床医生听取我对糖尿病管理的意见”这一项从93.4%到82.2%不等；“我的临床医生支持我的糖尿病管理”这一项从89.9%到74.1%不等；“我的临床医生建议我可以改进自我管理的方法”这一项从93.2%到66.1%不等；“我能理解临床医生的建议”这一项从96.6%到85.7%不等；“我能信任临床医生的建议”这一项从98.9%到82.2%不等；“临床医生的建议与糖尿病团队的其他成员一致”这一项从86.5%到67.9%不等。糖尿病教育者在共同决策的所有方面获得的评分最高。所有咨询中对共同决策的平均加权同意率为84.3%。焦点小组参与者报告说他们积极寻找践行共同决策的临床医生。缺乏共同决策经常被引述为停止咨询的一个原因。焦点小组讨论中占主导地位的三个主题是临床医生是否认可患者的专业知识、鼓励患者的自主性以及提供患者可用于改善自我管理的建议。
大多数临床医生参与了共同决策。患有1型糖尿病的年轻成年人更喜欢这样的临床医生。当临床医生不践行以患者为中心的医疗的这一组成部分时，他们可能不会接受推荐的医疗服务。这些发现对患者安全、改善健康结果和提高医疗服务质量具有重要意义。
