School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, BC, Canada.
Allergy. 2017 May;72(5):705-712. doi: 10.1111/all.13090. Epub 2017 Jan 27.
A shared approach to decision-making framework has been suggested for chronic disease management especially where multiple treatment options exist. Shared decision-making (SDM) requires that both physician and patients are actively engaged in the decision-making process, including information exchange; expressing treatment preferences; as well as agreement over the final treatment decision. Although SDM appears well supported by patients, practitioners and policymakers alike, the current challenge is to determine how best to make SDM a reality in everyday clinical practice. Within the context of asthma, adherence rates are poor and are linked to outcomes such as reduced asthma control, increased symptoms, healthcare expenditures, and lower patient quality of life. It has been suggested that SDM can improve treatment adherence and that ignoring patients' personal goals and preferences may result in reduced rates of adherence. Furthermore, understanding predictors of poor treatment adherence is a necessary step toward developing effective strategies to improve the patient-reported and clinically important outcomes. Here, we describe why a shared approach to treatment decision-making for asthma has the potential to be an effective tool for improving adherence, with associated clinical and patient-related outcomes. In addition, we explore insights into the reasons why SDM has not been implemented into routine clinical practice.
已经提出了一种用于慢性病管理的决策制定框架的共享方法，特别是在存在多种治疗选择的情况下。共同决策（SDM）要求医生和患者都积极参与决策过程，包括信息交流；表达治疗偏好；以及对最终治疗决策达成一致。尽管 SDM 似乎得到了患者、医生和政策制定者的一致支持，但当前的挑战是确定如何在日常临床实践中最好地实现 SDM。在哮喘的背景下，治疗的依从性很差，与哮喘控制的降低、症状的增加、医疗保健支出以及患者生活质量的降低等结果相关。有人认为，SDM 可以提高治疗的依从性，而忽视患者的个人目标和偏好可能会导致依从性降低。此外，了解治疗依从性差的预测因素是制定有效策略以改善患者报告和临床重要结果的必要步骤。在这里，我们描述了为什么针对哮喘的治疗决策制定的共享方法有可能成为提高依从性的有效工具，以及与之相关的临床和患者相关的结果。此外，我们还探讨了 SDM 为何未被纳入常规临床实践的原因。
