Rocque Gabrielle, Miller-Sonnet Ellen, Balch Alan, Stricker Carrie, Seidman Josh, Stiles Susan, Ruggerio John, Paynter Nancy, Lewis Mark, Kamal Arif
1 Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, Birmingham, AL, USA.
2 CancerCare, New York, NY, USA.
J Palliat Care. 2019 Jan;34(1):29-31. doi: 10.1177/0825859718810723. Epub 2018 Nov 1.
Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.
尽管共享决策（SDM）方法在患者与肿瘤学家之间的定期整合被视为最佳实践，但它仍是一个难以实现的目标。显然，需要实用、可行且实际的工具来推动肿瘤学领域更多地采用共享决策。为实现这一目标，我们召集了一个多学科协作团队，成员包括医疗保健服务生态系统中的专家，以确定在常规肿瘤学实践中设计和测试促进共享决策的流程的关键原则。在这篇评论中，我们描述了应对与实施共享决策相关挑战的3个最佳实践，这些实践源自一个多学科协作：（1）让对共享决策感兴趣的不同利益相关者参与进来；（2）在既定概念框架内开发并验证基于证据的共享决策工具；（3）制定必要的路线图，并考虑促使患者参与决策所需的基础设施。我们认为这3项原则对于创建可在临床实践内外使用的共享决策工具的成功至关重要。我们乐观地认为，跨环境的共享使用将支持该工具的采用，并克服在繁忙临床工作流程中实施共享决策的障碍。最终，我们希望这项工作能为对患者重要的事项提供新的视角，并为在决策中利用患者偏好和价值观提供重要动力。
