Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
Int Psychogeriatr. 2022 Oct;34(10):929-939. doi: 10.1017/S1041610222000205. Epub 2022 Mar 31.
Shared decision making is the process in which the person, their representative, and health care professional share information with each other, participate in the decision-making process, and agree on a course of action. At present, very little is known about shared decision making (SDM) in medication management from the perspective of long-term care facility residents. The objective of this study was to identify residents' beliefs, motivation, and aspects of the environment that facilitate or impede SDM.
A qualitative study was conducted using face-to-face semi-structured interviews, and data analysis was carried out using a thematic approach.
Six long-term care facilities in Sydney, Australia.
Thirty-one residents.
Enablers to resident involvement in SDM were resident beliefs in exercising their right to take part in medication-related decisions, preference to maintain control over decisions, and motivation to raise concern about medication. Residents were not motivated to be involved in SDM if they believed they had no control over life circumstance, perceived that medications were necessary, or experienced no problems with their medications. Participation in SDM was hindered by limitations in opportunities for resident involvement, engagement with staff and primary care physician to discuss issues related to medications, and continuity of care with their regular physician.
This study highlights that the residents' beliefs in control over decisions and concerns about medication are a significant function of the SDM process. It is important that residents are given the choice to take part in SDM, their beliefs and values regarding SDM are understood, and the culture of the care facility respects residents' right to participate in SDM.
共同决策是指患者、其代表和医疗保健专业人员相互分享信息、参与决策过程并就行动方案达成一致的过程。目前，对于长期护理机构居民在药物管理方面的共同决策（SDM），我们知之甚少。本研究的目的是确定居民在药物管理方面的信念、动机以及促进或阻碍 SDM 的环境因素。
采用面对面半结构化访谈进行定性研究，使用主题分析方法进行数据分析。
澳大利亚悉尼的六家长期护理机构。
31 名居民。
居民参与 SDM 的促进因素包括：居民相信自己有权参与与药物相关的决策、偏好保持对决策的控制以及有动力提出对药物的关注。如果居民认为自己无法控制生活环境、认为药物是必要的或对药物没有问题，则不会有参与 SDM 的动力。居民参与 SDM 的障碍包括参与机会有限、与工作人员和初级保健医生就药物相关问题进行沟通的机会有限以及与常规医生的连续性护理。
本研究强调，居民对决策的控制信念和对药物的关注是 SDM 过程的重要功能。重要的是，要给予居民参与 SDM 的选择权，了解他们对 SDM 的信念和价值观，并尊重护理机构的文化，尊重居民参与 SDM 的权利。
