Lamb Christopher C, Wang Yunmei
BioSolutions Services, Englewood Cliffs, New Jersey, United States; Department of Management and Entrepreneurship, Silberman College of Business, Fairleigh Dickinson University, Teaneck, New Jersey, United States; Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA.
Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106, USA.
Patient Educ Couns. 2020 Nov;103(11):2280-2289. doi: 10.1016/j.pec.2020.05.021. Epub 2020 May 19.
Shared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation.
A multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender.
A patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians.
A patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions. Practice Implications Future SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.
推荐采用共同决策（SDM）来提高医疗质量。采用理性决策风格和以患者为中心方法的医生更有可能将共同决策纳入临床实践。本文探讨了某些医生特征，如性别、年龄、种族、经验和专业，如何解释患者的参与情况。
一个多组结构方程模型测试了医生决策风格、以患者为中心的护理、医生特征以及患者参与临床治疗决策之间的关系。330名治疗原发性免疫缺陷的医生完成了一项调查。对不同专业、年龄、种族、经验或性别的组间样本组反应进行了比较。
以患者为中心的方法是鼓励共同决策的主要因素，与医生决策风格无关，在治疗方案和产品选择方面均如此。以患者为中心对免疫学家、经验更丰富的医生或男性医生的积极影响更强。理性决策风格会增加非免疫学家、年长医生、白人医生、经验较少的医生和女性医生的参与度。
以患者为中心的方法、理性决策和某些医生特征有助于解释患者参与临床决策的情况。实践意义未来的共同决策研究和政策倡议应关注医生对慢性疾病采用以患者为中心方法的情况，以及与医生特征和决策风格相关的潜在偏见。
