Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA.
Z Evid Fortbild Qual Gesundhwes. 2022 Jun;171:144-149. doi: 10.1016/j.zefq.2022.04.031. Epub 2022 May 20.
Shared decision making (SDM) is defined as an approach in which clinicians and patients share the best available evidence when faced with the task of making decisions, and in which patients are supported to consider options to achieve informed preferences [1]. Over the past decade, SDM has been increasingly recognized as a component of value-based care in the US. There is greater acceptance overall that SDM is a key strategy for achieving patient-centered care, enhancing patient safety, and achieving the triple aim of better health, better care, and lower costs [2]. Essential elements of SDM include recognizing and acknowledging that a decision is required; knowing and understanding the best available evidence on risks and benefits; and incorporating the patient's values and preferences into the decision [3]. This paper provides an update of our previous review of SDM in the US published in 2017. We describe changes in healthcare policies to support SDM at the federal and state levels, the integration of SDM into clinical practice, and the role of implementation science to advance SDM. Finally, we discuss potential next steps to inform policies for SDM and facilitate uptake of SDM in clinical practice.
共同决策（SDM）的定义是一种方法，临床医生和患者在面临决策任务时共同利用最佳现有证据，并且支持患者考虑各种选择以实现知情偏好[1]。在过去的十年中，SDM 在美国已逐渐被视为基于价值的护理的组成部分。人们普遍接受，SDM 是实现以患者为中心的护理、增强患者安全性和实现更好的健康、更好的护理和更低的成本这三个目标的关键策略[2]。SDM 的基本要素包括认识到需要做出决策；了解并理解有关风险和收益的最佳现有证据；并将患者的价值观和偏好纳入决策[3]。本文更新了我们 2017 年在美国发表的关于 SDM 的综述。我们描述了联邦和州层面支持 SDM 的医疗保健政策的变化、将 SDM 整合到临床实践中以及实施科学在推进 SDM 方面的作用。最后，我们讨论了为 SDM 制定政策和促进 SDM 在临床实践中应用的潜在下一步措施。
