Elwyn Glyn, Lloyd Amy, May Carl, van der Weijden Trudy, Stiggelbout Anne, Edwards Adrian, Frosch Dominick L, Rapley Tim, Barr Paul, Walsh Thom, Grande Stuart W, Montori Victor, Epstein Ronald
The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA.
Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, UK.
Patient Educ Couns. 2014 Nov;97(2):158-64. doi: 10.1016/j.pec.2014.07.027. Epub 2014 Aug 13.
Existing theoretical work in decision making and behavior change has focused on how individuals arrive at decisions or form intentions. Less attention has been given to theorizing the requirements that might be necessary for individuals to work collaboratively to address difficult decisions, consider new alternatives, or change behaviors. The goal of this work was to develop, as a forerunner to a middle range theory, a conceptual model that considers the process of supporting patients to consider alternative health care options, in collaboration with clinicians, and others.
Theory building among researchers with experience and expertise in clinician-patient communication, using an iterative cycle of discussions.
We developed a model composed of five inter-related propositions that serve as a foundation for clinical communication processes that honor the ethical principles of respecting individual agency, autonomy, and an empathic approach to practice. We named the model 'collaborative deliberation.' The propositions describe: (1) constructive interpersonal engagement, (2) recognition of alternative actions, (3) comparative learning, (4) preference construction and elicitation, and (5) preference integration.
We believe the model underpins multiple suggested approaches to clinical practice that take the form of patient centered care, motivational interviewing, goal setting, action planning, and shared decision making.
决策与行为改变方面现有的理论工作主要关注个体如何做出决策或形成意图。对于个体为解决复杂决策、考虑新的选择或改变行为而进行协作所需的条件进行理论化探讨的关注较少。这项工作的目标是作为中程理论的先驱，开发一个概念模型，该模型考虑与临床医生及其他人员协作支持患者考虑其他医疗保健选择的过程。
由在医患沟通方面有经验和专业知识的研究人员通过反复讨论的循环来构建理论。
我们开发了一个由五个相互关联的命题组成的模型，该模型为遵循尊重个体能动性、自主性和共情实践伦理原则的临床沟通流程奠定了基础。我们将该模型命名为“协作审议”。这些命题描述了：（1）建设性的人际互动，（2）对替代行动的认识，（3）比较性学习，（4）偏好构建与引出，以及（5）偏好整合。
我们认为该模型为多种建议的临床实践方法提供了基础，这些方法包括以患者为中心的护理、动机性访谈、目标设定、行动计划和共同决策。
