Farr Institute of Health Informatics, University College London, London, UK.
Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK.
Europace. 2018 Aug 1;20(8):1243-1251. doi: 10.1093/europace/eux268.
Athletes with cardiac disorders frequently pose an ethical and medical dilemma to physicians assessing their eligibility to participate in sport. In recent decades, patient empowerment has been gaining increasing recognition in clinical decision-making. Empowerment is a process through which people are involved over the decisions and actions that affect their own lives. In the context of a cardiac disorder, empowerment means giving an athlete the chance to participate in the decision about whether or not to remain active in competition. Three models of treatment decision-making are described in this article, with progressive levels of empowerment: the paternalistic model (the athlete has a passive role), the shared-decision making model (both athlete and physician participate in the decision), and the informed-decision making (the decision is made by the athlete while the role of the physician is solely to provide information). This article critically discusses the issues involved in disqualification of athletes with cardiovascular disorders and suggests possible ways of incorporating patient empowerment in potentially career-ending decisions. The authors propose a model of empowerment, which gives patients the opportunity to choose how much, and if, they would like to be involved in the decision-making process.
患有心脏疾病的运动员经常给评估其参赛资格的医生带来伦理和医学上的困境。近几十年来，患者赋权在临床决策中越来越受到重视。赋权是一个过程，通过这个过程，人们参与影响自己生活的决策和行动。在心脏疾病的背景下，赋权意味着给予运动员机会参与关于是否继续参加比赛的决策。本文描述了三种治疗决策模型，赋权程度逐渐增加：家长式模型（运动员处于被动角色）、共享决策模型（运动员和医生都参与决策）和知情决策模型（决策由运动员做出，而医生的角色仅在于提供信息）。本文批判性地讨论了因心血管疾病而取消运动员参赛资格所涉及的问题，并提出了在可能终结职业生涯的决策中纳入患者赋权的可能方法。作者提出了一种赋权模式，为患者提供了选择参与决策过程的程度和是否参与的机会。
