Navar Ann Marie, Stone Neil J, Martin Seth S
aDivision of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina bDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois cDivision of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Cardiol. 2016 Sep;31(5):537-44. doi: 10.1097/HCO.0000000000000322.
Current guidelines for cholesterol treatment emphasize the importance of engaging patients in a risk-benefit discussion prior to initiating statin therapy.
Although current risk prediction algorithms are well defined, there is less data on how to communicate with patients about cardiovascular disease risk, benefits of treatment, and possible adverse effects.
We propose a four-part model for effective shared decision-making: 1) Assessing patient priorities, perceived risk, and prior experience with cardiovascular risk reduction; 2) Arriving at a recommendation for therapy based on the patient's risk of disease, guideline recommendations, new clinical trial data, and patient preferences; 3) Communicating this recommendation along with risks, benefits, and alternatives to therapy following best practices for discussing numeric risk; and 4) Arriving at a shared decision with the patient with ongoing reassessment as risk factors and patient priorities change.
当前胆固醇治疗指南强调在开始他汀类药物治疗前让患者参与风险效益讨论的重要性。
尽管当前的风险预测算法已明确，但关于如何与患者就心血管疾病风险、治疗益处及可能的不良反应进行沟通的数据较少。
我们提出了一个用于有效共同决策的四部分模型：1）评估患者的优先事项、感知到的风险以及既往降低心血管风险的经验；2）根据患者的疾病风险、指南建议、新的临床试验数据以及患者偏好得出治疗建议；3）按照讨论数值风险的最佳实践，将此建议连同治疗的风险、益处和替代方案进行沟通；4）随着风险因素和患者优先事项的变化，与患者达成共同决策并持续重新评估。
