From the Cardiology Department, University of California, San Francisco, San Francisco, CA.
Cardiology Division, Cardiology Department, University of Texas Health Science Center, Houston, TX.
Cardiol Rev. 2023;31(1):52-56. doi: 10.1097/CRD.0000000000000434. Epub 2022 Mar 29.
Clinical decisions are optimally made collaboratively, with patients and clinicians working together to review all available information and treatment options. A comprehensive dialogue that identifies and brings into focus individual patient goals within the context of the evidence base is the ideal approach. Shared decision-making (SDM) is essential to making choices about treatment preferences and characterizes the optimal practice of evidence-based medicine and good patient care. By supporting patient autonomy and engagement, the patient and family become partners in their health care. Decisions surrounding whether or not to proceed with diagnostic and therapeutic procedures after fully discussing appropriate alternatives are best made considering both the evidence base and patient goals. The central feature of SDM is that a clinician and a patient engage in a dialogue to jointly make decisions, with reciprocated sharing of information that both find beneficial to reach the best decision. SDM entails much more than patient education or informed consent: there must be bidirectional transfer of knowledge, discussion of patient preference, and a process of deliberation reaching consensus. Patient decision aids have been shown to improve patient understanding of options and risks, enhance the patient's involvement, and focus their comprehension of treatment preferences. Patient decision aids also may be of value in strengthening the physician-patient relationship. The need to emphasize SDM should be integrated into the quality process at every level to make it meaningful, not an apparently arbitrary obstacle that requires discovery of a shrewd work-around. A more patient-oriented consideration of the benefits of symptom relief and improved quality of life, in addition to survival and freedom from adverse events, could only be beneficial.
临床决策最好是协作制定的，让患者和临床医生共同审查所有可用的信息和治疗方案。这种方法要在循证医学的背景下，全面开展对话，明确并关注患者的个体目标。共同决策（SDM）对于治疗偏好的选择至关重要，也是循证医学和良好患者护理的最佳实践的特征。通过支持患者自主权和参与度，患者及其家属成为医疗保健的合作伙伴。在充分讨论适当的替代方案后，是否继续进行诊断和治疗程序的决策，最好考虑到循证医学依据和患者目标。SDM 的核心特征是临床医生和患者进行对话以共同做出决策，同时互惠地共享双方都认为有助于做出最佳决策的信息。SDM 不仅仅是患者教育或知情同意：必须进行双向知识转移、讨论患者偏好，并进行审议以达成共识。患者决策辅助工具已被证明可以提高患者对各种选择和风险的理解，增强患者的参与度，并帮助他们集中理解治疗偏好。患者决策辅助工具也可能有助于加强医患关系。需要将强调 SDM 纳入到各级质量流程中，使其具有意义，而不是看似任意的障碍，需要巧妙地克服。除了生存和避免不良事件外，更注重患者对症状缓解和生活质量改善的获益，只会有好处。
