Hart Joanna L, Pflug Emily, Madden Vanessa, Halpern Scott D
1 Division of Pulmonary, Allergy, and Critical Care Medicine.
2 Leonard Davis Institute of Health Economics.
Am J Respir Crit Care Med. 2016 Feb 1;193(3):321-9. doi: 10.1164/rccm.201505-0882OC.
The goal of shared decision making is to match patient preferences, including evaluation of potential future outcomes, with available management options. Yet, it is unknown how patients with smoking-related thoracic diseases or their surrogates display future-oriented thinking.
To document prevalent themes in patients' and potential surrogate decision makers' future-oriented thinking when facing preference-sensitive choices.
We conducted 44 scenario-based semistructured interviews among a diverse group of outpatients with smoking-associated thoracic diseases and potential surrogates for whom one of three preference-sensitive decisions would be medically relevant. Using content analysis, we documented prevalent themes to understand how these individuals display future-oriented thinking.
Patients and potential surrogates generally expressed expectations for future outcomes but also acknowledged their limitations in doing so. When thinking about potential outcomes, decision makers relied on past experiences, including those only loosely related; perceived familiarity with treatment options; and spirituality. The content of these expectations included effects on family, emotional predictions, and prognostication. For surrogates, a tension existed between hope-based and fact-based expectations.
Patients and surrogates may struggle to generate expectations, and these future-oriented thoughts may be based on loosely related past experiences or unrealistic optimism. These tendencies may lead to errors, preventing selection of treatments that promote true preferences. Clinicians should explore how decision makers engage in future-oriented thinking and what their expectations are as a component of the shared decision-making process. Future research should evaluate whether targeted guidance in future-oriented thinking may improve outcomes important to patients.
共同决策的目标是使患者的偏好（包括对潜在未来结果的评估）与可用的管理选项相匹配。然而，尚不清楚患有吸烟相关胸科疾病的患者或其替代决策者如何表现出前瞻性思维。
记录患者及其潜在替代决策者在面对偏好敏感选择时前瞻性思维中的普遍主题。
我们对患有吸烟相关胸科疾病的不同门诊患者群体及其潜在替代者进行了44次基于情景的半结构化访谈，其中三个偏好敏感决策之一在医学上具有相关性。通过内容分析，我们记录了普遍主题，以了解这些个体如何表现出前瞻性思维。
患者和潜在替代者通常表达了对未来结果的期望，但也承认自己在这方面的局限性。在思考潜在结果时，决策者依赖于过去的经验，包括那些只是松散相关的经验；对治疗选择的感知熟悉度；以及灵性。这些期望的内容包括对家庭的影响、情感预测和预后。对于替代者来说，基于希望的期望和基于事实的期望之间存在紧张关系。
患者和替代者可能难以产生期望，这些前瞻性思维可能基于松散相关的过去经验或不切实际的乐观态度。这些倾向可能导致错误，妨碍选择符合真正偏好的治疗方法。临床医生应探索决策者如何进行前瞻性思维，以及他们的期望是什么，作为共同决策过程的一个组成部分。未来的研究应评估针对前瞻性思维的有针对性指导是否可以改善对患者重要的结果。
