Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
The University of California, San Francisco-East Bay, Oakland, CA, USA.
Health Expect. 2017 Dec;20(6):1248-1253. doi: 10.1111/hex.12564. Epub 2017 May 2.
Engaging patients in shared decision making involves patient knowledge of treatment options and physician elicitation of patient preferences.
Our aim was to explore patient and physician perceptions of shared decision making in clinical encounters for cancer care.
Patients and physicians were asked open-ended questions regarding their perceptions of shared decision making throughout their cancer care. Transcripts of interviews were coded and analysed for shared decision-making themes.
At an academic medical centre, 20 cancer patients with a range of cancer diagnoses, stages of cancer and time from diagnosis, and eight physicians involved in cancer care were individually interviewed.
Most physicians reported providing patients with written information. However, most patients reported that written information was too detailed and felt that the physicians did not assess the level of information they wished to receive. Most patients wanted to play an active role in the treatment decision, but also wanted the physician's recommendation, such as what their physician would choose for him/herself or a family member in a similar situation. While physicians stated that they incorporated patient autonomy in decision making, most provided data without making treatment recommendations in the format preferred by most patients. We identified several communication gaps in cancer care. While patients want to be involved in the decision-making process, they also want physicians to provide evidence-based recommendations in the context of their individual preferences. However, physicians often are reluctant to provide a recommendation that will bias the patient.
让患者参与共同决策需要患者了解治疗方案，以及医生了解患者的偏好。
我们旨在探讨癌症护理临床实践中患者和医生对共同决策的看法。
患者和医生被问到有关他们在癌症护理过程中对共同决策的看法的开放式问题。对访谈的文字记录进行编码和分析，以确定共同决策主题。
在一家学术医疗中心，对 20 名癌症患者（具有不同的癌症诊断、癌症分期和诊断后时间）和 8 名参与癌症护理的医生进行了个体访谈。
大多数医生报告说为患者提供了书面信息。然而，大多数患者报告说书面信息过于详细，并且认为医生没有评估他们希望接收的信息水平。大多数患者希望在治疗决策中发挥积极作用，但也希望医生提出建议，例如他们的医生在类似情况下会为自己或家人选择什么。虽然医生表示他们在决策中纳入了患者的自主权，但大多数医生在大多数患者偏好的格式中提供数据而不提出治疗建议。我们在癌症护理中发现了几个沟通差距。虽然患者希望参与决策过程，但他们也希望医生根据他们的个人偏好提供基于证据的建议。然而，医生通常不愿意提供可能影响患者的建议。
