The Dartmouth Institute for Health Policy and Clinical Practice, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756, USA.
Patient Educ Couns. 2021 Jul;104(7):1591-1595. doi: 10.1016/j.pec.2020.11.032. Epub 2020 Dec 1.
Cooperation has emerged as a fundamental characteristic of human society, and many argue that this ability is the basis for the phenomenal development in our capability as a species. When we focus our attention to the interactions that occur in healthcare, we inevitably notice power asymmetry due to unequal knowledge, experience, and status. However, as many have argued since the 1970s, there is an ethical imperative to respect the agency of individuals, offer information, collaborate, and support deliberation when difficult decisions arise. This process is particularly important when reasonable alternative courses of action exist and where the priorities and preferences of individuals would be expected to sway such decisions. This position article argues that this process, commonly described as shared decision making, involves work that is cognitive, emotional, and relational, and, particularly if people are ill, should have the underpinning goal of restoring autonomy. It covers the origin of the term and describes the core components; it describes how to do the cognitive, emotional, and relational work that is required, and offers a model to guide the process.
合作已成为人类社会的基本特征，许多人认为，这种能力是我们作为一个物种在能力方面显著发展的基础。当我们将注意力集中在医疗保健中发生的相互作用时，由于知识、经验和地位不平等，我们不可避免地会注意到权力不对称。然而，自 20 世纪 70 年代以来，许多人认为，尊重个人的代理权、提供信息、协作以及在出现困难决策时支持审议是符合伦理要求的。当存在合理的替代行动方案，并且个人的优先事项和偏好预计会影响这些决策时，这个过程尤其重要。本文认为，这一通常被描述为共同决策的过程涉及认知、情感和关系方面的工作，如果人们生病了，这一过程尤其应该以恢复自主性为根本目标。它涵盖了这个术语的起源，并描述了核心组成部分；它描述了如何完成所需的认知、情感和关系方面的工作，并提供了一个模型来指导这一过程。
