非医师医疗保健专业人员之间的共同决策：增强社区医疗保健环境中妇女生殖健康的患者参与度。

Shared decision-making among non-physician healthcare professionals: Enhancing patient involvement in women's reproductive health in community healthcare settings.

机构信息

Division of Consumer Science, Purdue University, West Lafayette, IN, USA.

Department of Public Health, Purdue University, West Lafayette, IN, USA.

出版信息

Patient Educ Couns. 2021 Sep;104(9):2304-2316. doi: 10.1016/j.pec.2021.02.032. Epub 2021 Feb 17.

DOI:10.1016/j.pec.2021.02.032

PMID:33685762

Abstract

OBJECTIVE

Shared decision-making (SDM) is an important approach to patient-centered care in women's reproductive healthcare. This study explored SDM experiences and perceptions among non-physician healthcare professionals.

METHODS

We completed 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes.

RESULTS

Professionals noted community-based healthcare required contextualized decision-making approaches. Results identified listening, decisional ownership, and engagement strategies that enhanced SDM involvement. Findings suggested outcome-oriented SDM concepts, including decisional ownership and investigative listening to enhance SDM. Providers redefined 'challenging' patients as engaged in their healthcare and discussed ways SDM improved healthcare experience beyond one visit.

CONCLUSION

Findings offered insight into actionable and practical strategies for enhancing SDM in community-based women's reproductive healthcare. The findings offer strategies to improve SDM by addressing barriers and facilitators among professionals. This extends SDM beyond the patient-physician dyad and supports broader application of SDM.

PRACTICE IMPLICATIONS

Incorporating professionals' experiences into SDM concepts can enhance SDM in community-based women's healthcare practice, offering opportunities to support a culture of SDM across settings.

摘要

目的

共享决策（SDM）是妇女生殖保健中以患者为中心的护理的重要方法。本研究探讨了非医师医疗保健专业人员的 SDM 经验和看法。

方法

我们于 2019 年 9 月至 2020 年 5 月在印第安纳州对 20 名非医师医疗保健专业人员（即 NP、RN、CNM、导乐、药剂师、脊椎按摩师）进行了关键知情者访谈，他们提供了基于社区的妇女生殖保健服务。采访进行了录音、转录，并使用扩展的扎根理论框架进行了分析。恒定性比较分析确定了新出现的主题。

结果

专业人员指出，基于社区的医疗保健需要采用情境化的决策方法。研究结果确定了增强 SDM 参与的倾听、决策所有权和参与策略。研究结果表明，以结果为导向的 SDM 概念，包括决策所有权和调查性倾听，可增强 SDM。提供者将“具有挑战性”的患者重新定义为对自己的医疗保健感兴趣，并讨论了 SDM 如何改善一次就诊以外的医疗保健体验。