Department of Anaesthesia, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX UK ; Division of Surgery and Interventional Science, 4th Floor, University College London, 21 University Street, London, WC1E 6AU UK ; Academy of Medical Royal Colleges, 10 Dallington Street, London, EC1V 0DB UK.
UCLH NIHR Surgical Outcomes Research Centre, Department of Anaesthetics, 3rd floor, Maples Link Corridor, University College Hospital, 235 Euston Road, London, NW1 2BU UK ; Centre for Anaesthesia, University College London, 3rd floor, Maples Link Corridor, University College Hospital, 235 Euston Road, London, NW1 2BU UK ; National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, WC1R 4SG London, UK ; University College Hospital NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
Perioper Med (Lond). 2016 Jun 16;5:16. doi: 10.1186/s13741-016-0042-3. eCollection 2016.
Surgical ambition is rising, with the Royal College of Surgeons reporting an increase in the number of procedures by a million over the past decade (Royal College of Surgeons. Surgery and the NHS in Numbers. Available from https://www.rcseng.ac.uk). Underpinning, this is a rapidly growing population, especially those in the over 85 age group, coupled with rising perioperative expertise; options for surgery are now present where conditions were once managed conservatively. Matching the right patient to the right procedure has never been so pertinent (Bader, Am Soc Anesthesiol 78(6), 2014). At the heart of these increasingly complex decisions, which may prove fatal or result in serious morbidity, lies the aspiration of shared decision-making (SDM) (Glance et al., N Engl J Med 370:1379-81, 2014). Shared decision-making is a patient-centred approach taking into account the beliefs, preferences and views of the patient as an expert in what is right for them, supported by clinicians who are the experts in diagnostics and valid therapeutic options (Coulter and Collins, Making shared decision-making a reality: no decision about me, without me, 2011). It has been described as the pinnacle of patient-centred care (Barry et al., N Engl J Med 366:780-1, 2012). In this commentary, we explore further the concept of shared decision-making, supported by a recent article which highlights critical deficits in current perioperative practice (Ankuda et al., Patient Educ Couns 94(3):328-33, 2014). This article was chosen for the purposes of this commentary as it is a large study across several surgical specialties investigating preoperative shared decision-making, and to our knowledge, the only of this kind.
手术的雄心正在上升，皇家外科学院报告在过去十年中手术数量增加了一百万（皇家外科学院。手术和国民保健制度的数据。可从 https://www.rcseng.ac.uk 获取）。在此基础上，人口迅速增长，尤其是 85 岁以上的人群，加上围手术期专业知识的不断提高；现在，曾经需要保守治疗的疾病也可以选择手术。为合适的患者选择合适的手术方式从未如此重要（Bader，美国麻醉医师学会 78（6），2014）。在这些日益复杂的决策的核心，这些决策可能导致致命或严重的发病率，在于共享决策（SDM）的愿望（Glance 等人，新英格兰医学杂志 370:1379-81, 2014）。共享决策是一种以患者为中心的方法，考虑到患者作为对他们自己最了解的人的信念、偏好和观点，由临床医生作为诊断和有效治疗选择的专家提供支持（Coulter 和 Collins，使共享决策成为现实：没有我，没有我的决定，2011）。它被描述为以患者为中心的护理的顶峰（Barry 等人，新英格兰医学杂志 366:780-1, 2012）。在这篇评论中，我们进一步探讨了共享决策的概念，这得到了一篇最近的文章的支持，该文章强调了当前围手术期实践中的关键缺陷（Ankuda 等人，患者教育与咨询 94（3）：328-33, 2014）。选择这篇文章是为了本评论的目的，因为它是一项涉及多个外科专业的关于术前共享决策的大型研究，据我们所知，这是此类研究中的唯一一项。
