Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Nephrology (Carlton). 2021 Nov;26(11):851-857. doi: 10.1111/nep.13902. Epub 2021 May 30.
Patients with chronic kidney disease are required to make difficult decisions, negotiating between the risks, burdens and benefits for any proposed course. This process can be extremely challenging, since these decisions involve inherent risks, which can impact on survival and quality of life. Shared decision-making offers a patient-centred approach in partnering with patients to make decisions about their treatment, which reflect their values and preferences. Shared decision-making can improve patient preparedness, motivation, satisfaction, and adherence to the treatment or decision agreed upon. In this review article, we outline the key principles of shared decision-making, and provide a framework with communication strategies to facilitate shared decision-making. We highlight the broad range and context of decisions faced by patients in several areas of nephrology care and discuss patient-important outcomes, priorities and motivations that underpin their decision-making. Preserving patient autonomy through shared decision-making ensures close consideration of patient preferences to enhance satisfaction with the decision reached and optimize outcomes important to patients.
慢性肾脏病患者需要做出艰难的决策，在任何建议的治疗方案的风险、负担和获益之间进行权衡。这个过程可能极具挑战性，因为这些决策涉及固有风险，可能会对生存和生活质量产生影响。共同决策为以患者为中心的方法，与患者合作做出关于其治疗的决策，反映他们的价值观和偏好。共同决策可以提高患者的准备程度、动力、满意度和对所商定的治疗或决策的依从性。在这篇综述文章中，我们概述了共同决策的关键原则，并提供了一个沟通策略框架，以促进共同决策。我们强调了肾病学护理几个领域的患者所面临的广泛决策范围和背景，并讨论了支撑他们决策的患者重要结局、优先事项和动机。通过共同决策维护患者自主权，可以确保仔细考虑患者的偏好，从而提高对决策的满意度，并优化对患者重要的结局。
