Guirguis Micheal, Thompson Erin, Miller Jenna, Sommer Ryan, Curran-Cook Danielle, Kaba Alyshah
Drug Stewardship Pharmacist Pharmacy Services, Drug Utilization and Stewardship, Alberta Health Services; Academic Adjunct Colleague Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Kaye Edmonton Clinic, Edmonton, Alberta, Canada.
Improving Health Outcomes Together, Alberta Health Services, Edmonton, Alberta, Canada.
J Patient Exp. 2021 Dec 6;8:23743735211064141. doi: 10.1177/23743735211064141. eCollection 2021.
: Shared Decision-Making (SDM) is an inclusive approach where patients and providers work in partnership to make health care decisions that are grounded in clinical best practice and align with patient preferences and values. Despite a growing recognition that SDM can lead to improved outcomes and reductions in unnecessary health investigations, tensions exist between patient agency and a historically paternalistic model of health care. As an evolving ideology, the Research Team sought to better understand the current state, challenges, and implementation opportunities of SDM practices across the health system. : This study used a cross-sectional quality improvement design utilizing semistructured interviews to gather information from focus group participants. Five open-ended, qualitative questions were used to generate discussion on the perceptions of SDM and its role in clinical appropriateness in a variety of clinical contexts in our health system. A total of 12 focus groups (n = 95 participants) representative of patients and families, leaders, physicians, and frontline clinicians were engaged in the study. : Through a consensus-based approach, study results identified 4 recommendations based on 4 themes: Time, Communication, System Design, and Clinical Appropriateness. : There are no easy solutions to the challenges of enabling SDM; however, success will be dependent upon recognizing the importance of patient agency, while maintaining an inclusive and continuous stakeholder engagement with both patients and providers. Implementation of the 4 recommendations at the organizational level highlighted in this study can serve as a road map for other health care institutions and will require a gradual approach to transform the general principles of SDM into tangible solutions to meet the emerging needs at both the local and system level.
共享决策（SDM）是一种包容性方法，患者和医疗服务提供者通过合作做出基于临床最佳实践且符合患者偏好和价值观的医疗决策。尽管人们越来越认识到共享决策可带来更好的结果并减少不必要的健康检查，但患者自主权与历史上家长式的医疗模式之间仍存在紧张关系。作为一种不断发展的理念，研究团队试图更好地了解整个医疗系统中共享决策实践的现状、挑战和实施机会。
本研究采用横断面质量改进设计，利用半结构化访谈从焦点小组参与者那里收集信息。使用五个开放式定性问题来引发关于共享决策的认知及其在我们医疗系统各种临床环境中对临床适宜性的作用的讨论。共有12个代表患者和家属、领导者、医生和一线临床医生的焦点小组（n = 95名参与者）参与了该研究。
通过基于共识的方法，研究结果基于四个主题确定了四项建议：时间、沟通、系统设计和临床适宜性。
实现共享决策面临的挑战没有简单的解决方案；然而，成功将取决于认识到患者自主权的重要性，同时保持与患者和医疗服务提供者的包容性和持续的利益相关者参与。本研究中强调的在组织层面实施这四项建议可作为其他医疗机构的路线图，并且需要一种渐进的方法将共享决策的一般原则转化为切实可行的解决方案，以满足地方和系统层面新出现的需求。
