广义共享决策方法和患者问题。为有目的的 SDM 调整 AHRQ 的 SHARE 方法。
Generalized shared decision making approaches and patient problems. Adapting AHRQ's SHARE Approach for Purposeful SDM.
机构信息
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester USA.
Center for Evidence and Practice Improvement of the Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA.
出版信息
Patient Educ Couns. 2020 Oct;103(10):2192-2199. doi: 10.1016/j.pec.2020.06.022. Epub 2020 Jun 27.
OBJECTIVE
Generalized shared decision making (SDM) describes the involvement of patients in choosing options. However, there are many situations in which patients and clinicians make decisions together that don't focus on choosing between options, e.g. problem-solving dialysis and insulin use while traveling. Poor uptake associated with clinicians' perception that SDM doesn't apply to clinical situations they face may reflect the lack of adaptation of generalized SDM approaches to patients' problems. The Purposeful SDM schema published in 2019 identifies problems for which different kinds of SDM are appropriate.
METHODS
The U.S. Agency for Healthcare Research and Quality developed SHARE as a generalized SDM approach. We sought to adapt SHARE to the different problems that patients face using a matrix to relate SHARE steps and Purposeful SDM modes and describe changes in generalized concepts and practices of SDM across these modes.
RESULTS
Many SHARE communicative behaviors applied across modes, although the meaning of SDM terms and practices, e.g. patients involved as problem solvers versus experts, varied substantially.
CONCLUSION
Aspects of SHARE require adaptation to different patient problems.
PRACTICE IMPLICATIONS
SDM in education, practice, and tools may be supported by adapting generalized SDM approaches to patients' problems.
目的
广义共享决策（SDM）描述了患者参与选择方案的过程。然而，在许多情况下，患者和临床医生共同做出决策，这些决策并不专注于在选项之间进行选择，例如解决透析和旅行中使用胰岛素的问题。临床医生认为 SDM 不适用于他们所面临的临床情况，这可能导致接受度较差，这可能反映出广义 SDM 方法没有针对患者的问题进行调整。2019 年发布的有针对性的 SDM 模式确定了适合不同类型 SDM 的问题。
方法
美国医疗保健研究与质量局开发了 SHARE，作为一种广义的 SDM 方法。我们试图使用矩阵来调整 SHARE 以适应患者面临的不同问题，以描述不同模式下 SDM 的广义概念和实践的变化，从而使 SHARE 步骤与有针对性的 SDM 模式相关联。
结果
尽管 SDM 术语和实践的含义（例如，患者作为问题解决者还是专家参与）有很大差异，但许多 SHARE 交流行为适用于所有模式。
结论
SHARE 的各个方面需要根据不同的患者问题进行调整。
实践意义
通过将广义 SDM 方法适用于患者的问题，可以为教育、实践和工具中的 SDM 提供支持。
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