Mejia Andrea M, Smith Glenn E, Wicklund Meredith, Armstrong Melissa J
Department of Clinical and Health Psychology (AMM, GES), University of Florida College of Public Health and Health Professions; and Department of Neurology (MW, MJA), University of Florida College of Medicine, Gainesville, FL.
Neurol Clin Pract. 2019 Apr;9(2):160-164. doi: 10.1212/CPJ.0000000000000576.
Shared decision making (SDM) occurs when patients and clinicians consider patients' values and preferences while discussing medical evidence to inform healthcare decisions. SDM enables patients with mild cognitive impairment (MCI) to express values and preferences when making current healthcare decisions and presents a unique opportunity to inform future decision making in the case of further cognitive decline. However, clinicians often fail to facilitate SDM with patients with MCI. This review describes research pertaining to value solicitation, weighing of the medical evidence, and medical decision making for individuals with MCI, explores the role of caregivers, identifies barriers to and facilitators of SDM in MCI, and suggests strategies to optimize SDM for persons with MCI in neurology clinical practice. Further research is needed to identify more strategies for decision support for individuals affected by cognitive impairment.
当患者和临床医生在讨论医学证据以做出医疗决策时考虑患者的价值观和偏好时,就会出现共同决策(SDM)。共同决策使轻度认知障碍(MCI)患者在做出当前医疗决策时能够表达价值观和偏好,并为未来认知能力进一步下降时的决策提供了一个独特的机会。然而,临床医生往往未能促进与MCI患者的共同决策。本综述描述了与MCI患者的价值征求、医学证据权衡和医疗决策相关的研究,探讨了护理人员的作用,确定了MCI中共同决策的障碍和促进因素,并提出了在神经病学临床实践中优化MCI患者共同决策的策略。需要进一步研究以确定更多针对受认知障碍影响个体的决策支持策略。