Berger Zackary, Galasinski Dariusz, Scalia Peter, Dong Kimberly, Blunt Heather B, Elwyn Glyn
Johns Hopkins School of Medicine, Division of General Internal Medicine, and Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
Centre for Interdisciplinary Research into Health and Illness, University of Wroclaw, Poland.
Patient Educ Couns. 2022 Jul;105(7):1980-1987. doi: 10.1016/j.pec.2021.10.026. Epub 2021 Oct 22.
Our aim was to use critical discourse analysis (CDA) to examine the most widely cited definitions of shared decision making so that we can evaluate how language is used to position participants. Based on our conceptual understanding, we presumed that shared decision making involves acts of communication where processes are collaborative.
We used a CDA lens to closely examine the phrases, semantics, syntax, implied functions, and the social actions proposed in SDM definition texts. We conducted a systematic search guided by the PRISMA guidelines, to identify the most widely cited definitions of SDM.
A total of 72 studies met our inclusion criteria. While SDM is not consistently defined, it was striking to find that clinicians are constructed as active whereas patients were viewed to be passive participants. The definitions construct SDM to be a gift that the clinician has the power to offer, and the relationship in the definitions appears asymmetric, in which only one party seems to speak.
The SDM definitions examined convey a process characterized by a clinician who speaks, while a patient mostly listens, and is invited to contribute. An alternative definition might be constructed through references to joint activity via sentences in active voice.
Clinicians may be influenced by definitions of SDM that reinforce the positionality of active speaker versus passive recipient. Clearer definitions that address the constructs of power and roles may help support the implementation of SDM.
我们旨在运用批判性话语分析（CDA）来审视共享决策制定最常被引用的定义，以便我们能够评估语言是如何被用来定位参与者的。基于我们的概念理解，我们假定共享决策制定涉及沟通行为，且过程是协作性的。
我们运用CDA视角仔细研究共享决策制定（SDM）定义文本中提出的短语、语义、句法、隐含功能和社会行为。我们在PRISMA指南的指导下进行了系统检索，以确定SDM最常被引用的定义。
共有72项研究符合我们的纳入标准。虽然SDM没有得到一致的定义，但令人惊讶的是，临床医生被构建为积极的一方，而患者则被视为被动参与者。这些定义将SDM构建为临床医生有权提供的一种恩赐，并且定义中的关系似乎是不对称的，其中似乎只有一方在说话。
所研究的SDM定义传达了一个以临床医生说话、患者大多倾听并被邀请做出贡献为特征的过程。通过使用主动语态的句子来提及联合活动，可能会构建出另一种定义。
临床医生可能会受到SDM定义的影响，这些定义强化了主动说话者与被动接受者的定位。更清晰地定义权力和角色的构建可能有助于支持SDM的实施。
