有针对性的 SDM：一种基于问题的方法，用于照顾有共同决策的患者。
Purposeful SDM: A problem-based approach to caring for patients with shared decision making.
机构信息
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, USA.
出版信息
Patient Educ Couns. 2019 Oct;102(10):1786-1792. doi: 10.1016/j.pec.2019.07.020. Epub 2019 Jul 19.
OBJECTIVE
Patient involvement focused the growth of Shared Decision Making (SDM) in contemporary healthcare practice, research, and education. Whilst important, securing appropriate patient involvement or equipping patients to choose is not necessarily the principal purpose of SDM. The purpose of SDM like all medical decision making is to act well in response to a patient's problem, broadly conceived. In which situations and how SDM addresses patient problems is unclear. We seek to develop a purposeful approach to SDM that is oriented to the kinds of problems that SDM might help resolve.
METHODS
Through vignettes of the experience of a patient, Rachel we demonstrate different kinds of situations in which Rachel, her family, and clinicians need to make decisions together.
RESULTS
Different methods of SDM are needed in situations of: CONCLUSION: SDM may be understood as a range of methods that vary substantially with patients' situations and the purpose that they pursue.
PRACTICE IMPLICATIONS
Clinicians struggle to adopt SDM when they do not see it as relevant to clinical work. Orienting SDM to the problems that patients and clinicians routinely face may further SDM adoption, education, and research.
目的
患者参与促使共享决策（SDM）在当代医疗保健实践、研究和教育中得到发展。虽然患者参与很重要，但是确保适当的患者参与或使患者能够做出选择不一定是 SDM 的主要目的。SDM 的目的与所有医疗决策一样，都是为了妥善应对广义上患者的问题。SDM 在哪些情况下以及如何解决患者的问题尚不清楚。我们试图制定一种有针对性的 SDM 方法，这种方法针对的是 SDM 可能有助于解决的问题类型。
方法
通过患者 Rachel 的案例，我们展示了 Rachel、她的家人和临床医生需要共同做出决策的不同情况。
结果
在以下情况下需要不同的 SDM 方法：
当患者的情况和目标发生变化时，需要重新评估 SDM 的方法；
当患者和临床医生对治疗目标有不同的期望时，需要进行沟通和协商；
当患者有多种治疗选择时，需要提供信息和帮助患者做出决策。
结论
SDM 可以被理解为一系列方法，这些方法在很大程度上因患者的情况和他们追求的目的而有所不同。
实践意义
当临床医生认为 SDM 与临床工作不相关时，他们就会难以采用 SDM。将 SDM 与患者和临床医生经常面临的问题联系起来，可能会进一步促进 SDM 的采用、教育和研究。
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