Légaré France, Stacey Dawn, Forest Pierre-Gerlier, Coutu Marie-France, Archambault Patrick, Boland Laura, Witteman Holly O, LeBlanc Annie, Lewis Krystina B, Giguere Anik M C
Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Université Laval Research Institute for Primary Care and Health Services (CERSSPL-UL), Quebec, QC, Canada.
Faculty of Health Sciences University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Z Evid Fortbild Qual Gesundhwes. 2017 Jun;123-124:23-27. doi: 10.1016/j.zefq.2017.05.020. Epub 2017 May 20.
Canada's approach to shared decision making (SDM) remains as disparate as its healthcare system; a conglomerate of 14 public plans - ten provincial, three territorial and one federal. The healthcare research funding environment has been largely positive for SDM because there was funding for knowledge translation research which also encompassed SDM. The funding climate currently places new emphasis on patient involvement in research and on patient empowerment in healthcare. SDM fields have expanded from primary care to elder care, paediatrics, emergency and critical care medicine, cardiology, nutrition, occupational therapy and workplace rehabilitation. Also, SDM has reached out to embrace other health-related decisions including about home care and social care and has been adapted to Aboriginal decision making needs. Canadian researchers have developed new interprofessional SDM models that are being used worldwide. Professional interest in SDM in Canada is not yet widespread, but there are provincial initiatives in Alberta, British Columbia, Ontario, Quebec and Saskatchewan. Decision aids are routinely used in some areas, for example for prostate cancer in Saskatchewan, and many others are available for online consultation. The Patient Decision Aids Research Group in Ottawa, Ontario maintains an international inventory of decision aids appraised with the International Patient Decision Aid Standards. The Canada Research Chair in SDM and Knowledge Translation in Quebec City maintains a website of SDM training programs available worldwide. These initiatives are positive, but the future of SDM in Canada depends on whether health policies, health professionals and the public culture fully embrace it.
加拿大的共同决策（SDM）方法与其医疗保健系统一样参差不齐；它由14个公共计划组成——10个省级、3个地区级和1个联邦级。医疗保健研究资金环境在很大程度上对共同决策持积极态度，因为有用于知识转化研究的资金，其中也包括共同决策。目前的资金环境重新强调患者参与研究以及患者在医疗保健中的赋权。共同决策领域已从初级保健扩展到老年护理、儿科、急诊和重症医学、心脏病学、营养、职业治疗和工作场所康复。此外，共同决策已扩展到涵盖其他与健康相关的决策，包括家庭护理和社会护理方面的决策，并已根据原住民的决策需求进行了调整。加拿大研究人员开发了新的跨专业共同决策模型，这些模型正在全球范围内使用。加拿大对共同决策的专业兴趣尚未广泛普及，但艾伯塔省、不列颠哥伦比亚省、安大略省、魁北克省和萨斯喀彻温省都有省级举措。决策辅助工具在一些地区经常使用，例如萨斯喀彻温省用于前列腺癌的决策辅助工具，还有许多其他工具可供在线咨询。安大略省渥太华的患者决策辅助工具研究小组维护着一个按照国际患者决策辅助工具标准评估的决策辅助工具国际清单。魁北克市的加拿大共同决策与知识转化研究主席维护着一个全球可用的共同决策培训项目网站。这些举措是积极的，但加拿大共同决策的未来取决于卫生政策、卫生专业人员和公共文化是否能充分接受它。
