Clayman Marla L, Gulbrandsen Pål, Morris Megan A
American Institutes for Research, Chicago, USA.
Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; Akershus University Hospital, Lillestrøm, Norway.
Patient Educ Couns. 2017 Mar;100(3):600-604. doi: 10.1016/j.pec.2016.10.016. Epub 2016 Oct 21.
Interest in shared decision making (SDM) has increased and become widely promoted. However, from both practical and measurement perspectives, SDM's origin as an outgrowth of patient autonomy has resulted in narrowly conceptualizing and operationalizing decision making. The narrow focus on individual patient autonomy fails in four main ways: 1) excluding several facets of the roles, actions, and influences of decision partners in decision making; 2) focusing solely on the medical encounter; 3) ignoring the informational environment to which patients have access; and 4) treating each encounter as independent of all others. In addition to creating a research agenda that could answer important outstanding questions about how decisions are made and the consequences thereof, reconceiving SDM as centered on the person rather than the medical encounter has the potential to transform how illness is experienced by patients and families and how clinicians find meaning in their work.
对共同决策（SDM）的兴趣有所增加，并得到广泛推广。然而，从实践和衡量的角度来看，SDM起源于患者自主权，这导致了对决策的概念化和操作化过于狭隘。对个体患者自主权的狭隘关注在四个主要方面存在不足：1）排除了决策伙伴在决策中的角色、行动和影响的几个方面；2）仅关注医疗接触；3）忽视患者可获取的信息环境；4）将每次接触视为与其他所有接触无关。除了创建一个能够回答有关决策如何做出及其后果的重要未决问题的研究议程外，将SDM重新构想为以人而非医疗接触为中心，有可能改变患者和家庭对疾病的体验方式，以及临床医生在工作中找到意义的方式。
