Hellström Muhli Ulla, Trost Jan, Siouta Eleni
Department of Sociology, Uppsala University , Uppsala, Sweden.
Department of Neurobiology, Care Sciences and Society Division of Nursing, Karolinska Institute , Stockholm, Sweden.
Int J Health Care Qual Assur. 2019 May 13;32(4):765-776. doi: 10.1108/IJHCQA-10-2017-0194.
The purpose of this paper is to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions were: how cardiologists handle and provide scope for patient involvement in medical consultations regarding AF treatment and how cardiologists describe their familiarity with shared decision-making.
DESIGN/METHODOLOGY/APPROACH: A descriptive study was designed. Ten interviews with cardiologists at four Swedish hospitals were held, and a qualitative content analysis was performed on the collected data.
The analysis shows cardiologists' accounts of persuasive practice, protective practice, professional role and medical craftsmanship when it comes to patient involvement and shared decision-making. The term "shared decision-making" implies a concept of not only making one decision but also ensuring that it is finalised with a satisfactory agreement between both parties involved, the patient as well as the cardiologist. In order for the idea of patient involvement to be fulfilled, the two parties involved must have equal power, which can never actually be guaranteed.
RESEARCH LIMITATIONS/IMPLICATIONS: Methodologically, this paper reflects the special contribution that can be made by the research design of descriptive qualitative content analysis (Krippendorff, 2004) to reveal and understand cardiologists' perspectives on patient involvement and participation in medical consultation and shared decision-making. The utility of this kind of analysis is to find what cardiologists said and how they arrived at their understanding about patient involvement. Accordingly, there is no quantification in this type of research.
Cardiologists should prioritise patient involvement and participation in decision-making regarding AF treatment decisions in consultations when trying to meet the request of patient involvement.
ORIGINALITY/VALUE: Theoretically, the authors have learned that the patient involvement and shared decision-making requires the ability to see patients as active participants in the medical consultation process.
本文旨在分析瑞典心脏病专家关于患者参与心房颤动（AF）会诊的描述。问题如下：心脏病专家如何处理并为患者参与AF治疗的医学会诊提供空间，以及心脏病专家如何描述他们对共同决策的熟悉程度。
设计/方法/途径：设计了一项描述性研究。对瑞典四家医院的心脏病专家进行了十次访谈，并对收集到的数据进行了定性内容分析。
分析显示了心脏病专家在患者参与和共同决策方面的说服性实践、保护性实践、专业角色和医学技艺的描述。“共同决策”一词不仅意味着做出一个决策，还意味着确保该决策在患者和心脏病专家这两个相关方之间达成令人满意的共识后最终确定。为了实现患者参与的理念，两个相关方必须拥有平等的权力，但这实际上永远无法得到保证。
研究局限性/影响：从方法上讲，本文反映了描述性定性内容分析的研究设计（克里彭多夫，2004年）在揭示和理解心脏病专家对患者参与以及参与医学会诊和共同决策的观点方面所能做出的特殊贡献。这种分析的作用是找出心脏病专家所说的内容以及他们对患者参与的理解是如何形成的。因此，这类研究没有进行量化。
心脏病专家在试图满足患者参与的要求时，应优先考虑患者参与AF治疗决策的会诊并参与决策。
原创性/价值：从理论上讲，作者了解到患者参与和共同决策需要将患者视为医学会诊过程中的积极参与者的能力。
