心理健康专业人员针对精神障碍患者进行共同决策的经验：一项定性研究
Mental health professionals' experiences with shared decision-making for patients with psychotic disorders: a qualitative study.
作者信息
Haugom Espen W, Stensrud Bjørn, Beston Gro, Ruud Torleif, Landheim Anne S
机构信息
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P. B 104, 2381, Brumunddal, Norway.
Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.
出版信息
BMC Health Serv Res. 2020 Nov 27;20(1):1093. doi: 10.1186/s12913-020-05949-1.
BACKGROUND
Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient's preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals' experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals' SDM experiences with patients with psychotic disorders.
METHODS
Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis.
RESULTS
Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them.
CONCLUSION
Health professionals' understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.
背景
共同决策（SDM）是一个临床医生和患者共同合作，基于患者偏好和临床证据来选择治疗方案的过程。尽管患有精神障碍的患者希望更多地参与到有关其治疗的决策中，但由于各种障碍，他们这样做的机会有限。了解卫生专业人员在共同决策方面的经验对于成功实施该决策至关重要。本研究的目的是描述和探索卫生专业人员与患有精神障碍的患者共同决策的经验。
方法
进行了三次焦点小组访谈，共有18名在挪威三个社区心理健康中心之一工作的卫生专业人员参与，这些中心负责治疗患有精神障碍的患者。我们采用定性内容分析的描述性和探索性方法。
结果
卫生专业人员主要将共同决策的概念理解为向患者提供信息，并让他们在不同的抗精神病药物之间进行选择。在共同决策的障碍中，他们强调患有精神病的患者对自己的健康状况了解有限，并且需要时间来建立信任和联盟。卫生专业人员主要将患有精神障碍的患者视为一个自主决策能力有限的群体。他们在描述共同决策的概念时，很少考虑提出不同的治疗方案。心理或社会干预通常被视为抗精神病药物的补充，而不是替代药物。
结论
卫生专业人员对共同决策的理解与文献中常用的定义不一致。他们认为患有精神障碍的患者参与自身治疗决策的能力有限。这些发现表明，卫生专业人员需要在共同决策方面接受更多的理论和实践培训。
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