晚期重症疾病中的共同决策制定及患者决策辅助工具的使用：医疗服务提供者与患者的观点
Shared decision making and the use of a patient decision aid in advanced serious illness: provider and patient perspectives.
作者信息
Jones Jacqueline, Nowels Carolyn, Kutner Jean S, Matlock Daniel D
机构信息
College of Nursing, University of Colorado, Aurora, CO, USA.
School of Medicine, University of Colorado, Aurora, CO, USA.
出版信息
Health Expect. 2015 Dec;18(6):3236-47. doi: 10.1111/hex.12313. Epub 2014 Dec 1.
OBJECTIVE
Patients with advanced serious illness face many complex decisions. Patient decision aids (PtDAs) can help with complex decision making but are underutilized. This study assessed barriers and facilitators to the use of a PtDA designed for serious illness.
METHODS
Providers and patients were asked about their experiences in making decisions around serious illness and their opinions towards the PtDA. Seven focus groups were digitally recorded, transcribed and analysed using a general qualitative inductive method.
RESULTS
Domain 1 - clinical context within which the PtDA would be utilized including three themes: (1a) role: PtDA might compete with the physician's role; (1b) logistics: it was unclear when and how such a PtDA should be implemented; and (1c) meaning: what it will mean to the patient if the physician recommends viewing of this PtDA. Domain 2 - broader global context: (2a) death-denying culture; and (2b) physician concerns that the PtDA was biased towards palliative care.
CONCLUSION
Physicians' concerns were rooted in deeper concerns about palliative care and a death-denying culture. Patients were more open to using the PtDA than physicians, suggesting 'it's never too early'.
PRACTICE IMPLICATIONS
PtDAs for serious illness can maximize early opportunities for goals of care conversations and shared decision making.
目的
晚期重症患者面临许多复杂的决策。患者决策辅助工具（PtDAs）有助于复杂决策，但未得到充分利用。本研究评估了使用专为重症设计的PtDA的障碍和促进因素。
方法
询问医疗服务提供者和患者在围绕重症进行决策方面的经历以及他们对PtDA的看法。七个焦点小组进行了数字录音、转录，并采用一般定性归纳法进行分析。
结果
领域1 - PtDA将被使用的临床背景，包括三个主题：（1a）角色：PtDA可能与医生的角色竞争；（1b）后勤：不清楚何时以及如何实施这样的PtDA；（1c）意义：如果医生建议查看此PtDA对患者意味着什么。领域2 - 更广泛的全球背景：（2a）否认死亡的文化；（2b）医生担心PtDA偏向姑息治疗。
结论
医生的担忧源于对姑息治疗和否认死亡文化的更深层次担忧。患者比医生更愿意使用PtDA，这表明“越早越好”。
实践意义
针对重症的PtDAs可以最大限度地增加护理目标对话和共同决策的早期机会。
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