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围手术期医学中的共同决策:印度的情况仍有很长的路要走。

Shared decision making in peri-operative medicine: Miles to go in Indian scenario.

作者信息

Krishna Prasad G V

机构信息

Classified Specialist (Anaesthesiology) Military Hospital Kirkee, Pune, Maharashtra, India.

出版信息

J Anaesthesiol Clin Pharmacol. 2020 Jul-Sep;36(3):316-324. doi: 10.4103/joacp.JOACP_250_19. Epub 2020 Sep 26.

DOI:10.4103/joacp.JOACP_250_19
PMID:33487897
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7812941/
Abstract

Shared Decision Making (SDM) in peri-operative medicine is increasingly encouraged as an ideal model of treatment decision making in the medical encounter. Moreover, it has the potential to improve the quality of the decision-making process for patients and ultimately, patient outcomes. This review focuses on several published literature on SDM in peri-operative medicine, its Implementation, barriers faced by Patient and the Provider, Myths regarding SDM and current scenario of SDM in India. Within the anesthetic community, patient consent is vigorously guided. However, this community suffers from lack of advancements in implementing the patient-focused rather than doctor-focused characteristics of SDM. Out of the several barriers, the most common barrier towards the implementation of SDM is the lack of time from the provider community. Within the anesthesia domain, the consultations discussed directly preceding the surgery do not pursue the customary and highly organized stages of typical outpatient consultations. Under these backgrounds and to be successfully implemented, it becomes imperative to begin the process of SDM pre-operative assessment clinic targeting both the high- and low-risk patients. It is critical to summarise that SDM does not end at the time of anesthesia for the peri-operative healthcare professional, but it gets to carry forward until patient discharge. Therefore, it is carried as the Pinnacle of Patient-Centred Care.

摘要

围手术期医学中的共同决策(SDM)作为医疗过程中治疗决策的理想模式,越来越受到鼓励。此外,它有可能提高患者决策过程的质量,并最终改善患者的治疗结果。本综述聚焦于围手术期医学中关于SDM的几篇已发表文献,包括其实施情况、患者和医疗服务提供者面临的障碍、关于SDM的误解以及印度SDM的现状。在麻醉学界,患者同意受到严格指导。然而,该领域在实施以患者为中心而非以医生为中心的SDM特征方面缺乏进展。在诸多障碍中,实施SDM最常见的障碍是医疗服务提供者群体缺乏时间。在麻醉领域,手术前直接进行的会诊并未遵循典型门诊会诊的常规且高度有序的阶段。在这些背景下,为了成功实施,必须针对高风险和低风险患者启动SDM术前评估诊所流程。至关重要的是要总结,对于围手术期医疗专业人员而言,SDM并非在麻醉时结束,而是要持续到患者出院。因此,它被视为以患者为中心的医疗服务的巅峰。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/5bd77d9586ed/JOACP-36-316-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/9ee3019fe11c/JOACP-36-316-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/0f211e011004/JOACP-36-316-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/71d0ea6f6f07/JOACP-36-316-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/5bd77d9586ed/JOACP-36-316-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/9ee3019fe11c/JOACP-36-316-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/b87e7095a230/JOACP-36-316-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/0f211e011004/JOACP-36-316-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a689/7812941/71d0ea6f6f07/JOACP-36-316-g004.jpg
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本文引用的文献

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JMIR Res Protoc. 2018 Dec 4;7(12):e11072. doi: 10.2196/11072.
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Systematic review of shared decision-making in surgery.系统综述手术中的共享决策。
Br J Surg. 2018 Dec;105(13):1721-1730. doi: 10.1002/bjs.11009. Epub 2018 Oct 25.
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Patient autonomy and disclosure of material information about hospital-acquired infections.患者自主权与医院获得性感染相关重要信息的披露
Infect Drug Resist. 2018 Mar 7;11:369-375. doi: 10.2147/IDR.S149590. eCollection 2018.
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Shared decision making: relevant concepts and facilitating strategies.共同决策:相关概念与促进策略。
Epidemiol Health. 2017 Oct 30;39:e2017048. doi: 10.4178/epih.e2017048. eCollection 2017.
5
Shared decision making in preventive health care: What it is; what it is not.预防性医疗保健中的共同决策:是什么;不是什么。
Can Fam Physician. 2017 Sep;63(9):682-684.
6
Shared decision making in the UK: Moving towards wider uptake.英国的共同决策:迈向更广泛的应用
Z Evid Fortbild Qual Gesundhwes. 2017 Jun;123-124:99-103. doi: 10.1016/j.zefq.2017.05.010. Epub 2017 May 20.
7
Shared decision making, a buzz-word in the Netherlands, the pace quickens towards nationwide implementation….共同决策,在荷兰是个流行词,全国范围内实施的步伐正在加快……
Z Evid Fortbild Qual Gesundhwes. 2017 Jun;123-124:69-74. doi: 10.1016/j.zefq.2017.05.016. Epub 2017 May 19.
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Implementing shared decision making in the NHS: lessons from the MAGIC programme.在英国国家医疗服务体系(NHS)中实施共同决策:来自MAGIC项目的经验教训。
BMJ. 2017 Apr 18;357:j1744. doi: 10.1136/bmj.j1744.
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