MultiLing Center for Research on Multilingualism in Society across the Lifespan, Department of Linguistics and Scandinavian Studies, University of Oslo, Oslo, Norway; HØKH Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway.
Department of Internal Medicine, Nordland Hospital Trust, Bodø, Norway; HØKH Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Patient Educ Couns. 2017 Nov;100(11):2081-2087. doi: 10.1016/j.pec.2017.05.018. Epub 2017 Jun 19.
To explore how physicians bring up patient preferences, and how it aligns with assessments of shared decision-making.
Qualitative conversation analysis of physicians formulating hypotheses about the patient's treatment preference was compared with quantitative scores on SDM and 'patient preferences' using OPTION(5) and MAPPIN'SDM.
Physicians occasionally formulate hypotheses about patients' preferences and then present a treatment option on the basis of that ("if you think X+we can do Y"). This practice may promote SDM in that the decisions are treated as contingent on patient preferences. However, the way these hypotheses are formulated, simultaneously constrains the patient's freedom of choice and exerts a pressure to accept the physician's recommendation. These opposing effects may in part explain cases where different assessment instruments yield large variations in SDM measures.
Eliciting patient preferences is a complex phenomenon that can be difficult to reduce into an accurate number. Detailed analysis can shed light on how patient preferences are elicited, and its consequences for patient involvement. Comparing CA and SDM measurements can contribute to specifying communicative actions that SDM scores are based on.
Our findings have implications for SDM communication skills training and further development of SDM measurements.
探索医生如何提出患者偏好，以及这与对共享决策的评估如何一致。
对医生形成关于患者治疗偏好假设的定性对话分析，与使用 OPTION(5) 和 MAPPIN'SDM 对 SDM 和“患者偏好”的定量评分进行了比较。
医生偶尔会对患者的偏好形成假设，然后根据这些假设提出治疗方案（“如果您认为 X+，我们可以做 Y”）。这种做法可能会促进 SDM，因为这些决策被视为取决于患者的偏好。然而，这些假设的形成方式同时限制了患者的选择自由，并施加了接受医生建议的压力。这些相反的影响可能部分解释了为什么不同的评估工具在 SDM 测量中产生了很大的差异。
引出患者偏好是一个复杂的现象，很难准确地用数字表示。详细的分析可以揭示出如何引出患者的偏好，以及这对患者参与的影响。比较 CA 和 SDM 测量可以有助于确定 SDM 评分所依据的沟通行为。
我们的发现对 SDM 沟通技巧培训和 SDM 测量的进一步发展具有启示意义。
