Gallagher Joseph H, Vassy Jason L, Clayman Marla L
Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America.
Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Health Administration, Bedford MA and Boston MA, United States.
PEC Innov. 2023 Jan 24;2:100127. doi: 10.1016/j.pecinn.2023.100127. eCollection 2023 Dec.
Describe how applying a shared decision making (SDM) lens to the implementation of new technologies can improve patient-centeredness.
This paper argues that the emergence of polygenic risk scores (PRS) for cancer screening presents an illustrative opportunity to include SDM when novel technologies enter clinical care.
PRS are novel tools that indicate an individual's genetic risk of a given disease relative to the population. PRS are anticipated to help identify individuals most and least likely to benefit from screening. However, PRS have several types of uncertainty, including validity across populations, disparate computational methods, and inclusion of different genomic data across laboratories.
Implementing SDM alongside new technologies could prove useful for their ethical and patient-centered utilization. SDM's importance as an approach to decision-making will not diminish, as evidence, uncertainty, and patient values will remain intrinsic to the art and science of clinical care.
SDM can help providers and patients navigate the considerable uncertainty inherent in implementing new technologies, enabling decision-making based on existing evidence and patient values.
描述将共享决策（SDM）视角应用于新技术实施过程中如何提高以患者为中心的程度。
本文认为，癌症筛查多基因风险评分（PRS）的出现为新技术进入临床护理时纳入共享决策提供了一个具有启发性的机会。
PRS是一种新型工具，可表明个体相对于总体人群患特定疾病的遗传风险。预计PRS将有助于识别最有可能和最不可能从筛查中受益的个体。然而，PRS存在多种不确定性，包括在不同人群中的有效性、不同的计算方法以及各实验室纳入的基因组数据不同。
在新技术实施过程中同时采用共享决策可能有助于其符合伦理规范并以患者为中心地加以应用。共享决策作为一种决策方法的重要性不会降低，因为证据、不确定性和患者价值观仍将是临床护理艺术与科学的内在组成部分。
共享决策可帮助医疗服务提供者和患者应对新技术实施过程中固有的巨大不确定性，从而基于现有证据和患者价值观进行决策。
