Giuliani Enrico, Melegari Gabriele, Carrieri Francesca, Barbieri Alberto
Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.
Department of Anesthesia and Intensive Care, AOU Policlinico, Modena, Italy.
J Eval Clin Pract. 2020 Apr;26(2):520-523. doi: 10.1111/jep.13300. Epub 2019 Oct 29.
In shared decision making, health care professionals and patients collaborate in making health-related choices. This process is based on autonomy and constitutes one to the elements of patient-centered care. However, there are situations where shared decision making is more difficult, if not impossible, due to barriers, which may be related to language, culture, education, or mental capacity and external factors like the state of emergency or the availability of alternative sources of information.
The aim of this paper is to identify some of the main obstacles to the adoption of shared decision making in an intensive and critical care scenario and discuss potential ways to facilitate its implementation.
We conducted a literature review on shared decision making from the perspective of intensive and critical care specialists.
Although the health care context is complex and the variety of situation that can arise makes it impossible to prepare professionals for every occurrence, shared decision making process should be structured at an organization level, engaging health care professionals, experts of communication, and patient representatives coming from different cultural backgrounds, languages, and education to assemble for all the main procedures, where shared decision making is involved, the specific information packages health care professionals will use in order to guide them through the process and ensuring all patients receive a comparable level of engagement. Shared decision making should not become a hindrance for the health care professional but on the contrary a way to strengthen their relationship with the patient.
The implementation of the shared decision making approach at an organization-wide level improves its quality and effectiveness.
在共同决策中，医疗保健专业人员和患者共同协作做出与健康相关的选择。这一过程基于自主性，是患者为中心的医疗的要素之一。然而，在某些情况下，由于语言、文化、教育或心智能力等障碍以及诸如紧急状态或替代信息来源的可用性等外部因素，共同决策即使并非不可能，也会更加困难。
本文旨在识别重症和危重症护理场景中采用共同决策的一些主要障碍，并探讨促进其实施的潜在方法。
我们从重症和危重症护理专家的角度对共同决策进行了文献综述。
尽管医疗保健环境复杂，可能出现的情况多种多样，使得专业人员无法为每种情况做好准备，但共同决策过程应在组织层面进行构建，让来自不同文化背景、语言和教育程度的医疗保健专业人员、沟通专家和患者代表参与所有涉及共同决策的主要程序，准备好医疗保健专业人员将使用的特定信息包，以指导他们完成这一过程，并确保所有患者都能获得相当程度的参与。共同决策不应成为医疗保健专业人员的障碍，相反，应成为加强他们与患者关系的一种方式。
在全组织范围内实施共同决策方法可提高其质量和有效性。
