Elwyn Glyn, Durand Marie Anne, Song Julia, Aarts Johanna, Barr Paul J, Berger Zackary, Cochran Nan, Frosch Dominick, Galasiński Dariusz, Gulbrandsen Pål, Han Paul K J, Härter Martin, Kinnersley Paul, Lloyd Amy, Mishra Manish, Perestelo-Perez Lilisbeth, Scholl Isabelle, Tomori Kounosuke, Trevena Lyndal, Witteman Holly O, Van der Weijden Trudy
The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA.
BMJ. 2017 Nov 6;359:j4891. doi: 10.1136/bmj.j4891.
To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Multistage consultation process. Key informant group, communities of interest, and survey of clinical specialties. 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.
修订现有的三谈话模型以学习如何实现共同决策，并与相关利益相关者进行协商以进行更新并获得更广泛的参与。多阶段协商过程。关键信息提供者小组、利益相关群体以及临床专科调查。19名关键信息提供者、来自多个利益相关群体的153份成员回复，以及来自六个专科的具备医学资质的临床医生对在线调查的316份回复。经过三轮的广泛协商后，我们对三谈话模型进行了修订，对一个谈话类别进行了修改，增加了引出患者目标的必要性，为每个谈话类别提供了一套明确的任务，并添加了建议脚本以说明每个步骤。基于“团队谈话”“选项谈话”和“决策谈话”，提出了一种新的共同决策三谈话模型，以描述协作和审议的过程。团队谈话强调在患者了解选择时需要为其提供支持，并引出他们的目标，以此作为指导决策过程的一种方式。选项谈话是指运用风险沟通原则比较各种选择的任务。决策谈话是指在健康专业人员的经验和专业知识指导下，做出反映患者明智偏好的决策的任务。修订后的共同决策三谈话模型描述了对话步骤，首先在介绍选项时提供支持，接着采取比较和讨论权衡的策略，最后基于明智偏好进行审议。
