Safaei Jalil
Department of Economics, University of Northern British Columbia, Prince George, BC, Canada.
J Healthc Leadersh. 2015 Dec 16;7:123-136. doi: 10.2147/JHL.S70021. eCollection 2015.
There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care.
This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries.
Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care.
Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature.
Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is pursued more systematically in the broader sociopolitical domains.
关于协商民主、参与式民主或参与型民主存在大量文献。在医疗保健领域，过去几十年里，关于协商民主的文献迅速增多，体现在公众参与、共同决策（SDM）、以患者为中心的护理以及患者/医护人员自主权等各种概念中。回顾此类文献有助于了解在医疗保健中引入协商民主的挑战和前景。
本文回顾了医疗保健环境中关于协商民主和共同决策的关键文献，重点是确定在医疗保健中推广这种方法的主要挑战，并认识到其目前的进展，以便在发达国家背景下规划其未来前景。
搜索了几个数据库以确定与本研究主题相关的文献。共确定了56篇英文关键研究，并仔细审查，以寻找在医疗保健中促进协商民主的挑战和/或有前景途径的迹象和证据。
时间压力、缺乏经济激励、根深蒂固的专业利益、信息不平衡、实际可行性、成本、决策多样性和背景因素被指出是主要挑战。至于前景，在公众参与概念和政策目标上更加明确、当局真正致力于公众意见输入、记录公众参与有效性的证据、开发患者决策支持、对医护人员进行共同决策培训以及使用适合特定背景的多种灵活参与领导方法是综述文献中的主要发现。
在医疗保健中寻求协商民主既具有挑战性又有回报。挑战已或多或少得到确定。然而，其前景可能很可观。如果在更广泛的社会政治领域更系统地追求协商民主，这些前景更有可能实现。
