School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Department of Nursing, Wan Fang Hospital, Taipei, Taiwan.
BMJ Open. 2024 Feb 2;14(2):e075693. doi: 10.1136/bmjopen-2023-075693.
Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan.
In-depth interviews and thematic analysis.
Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022.
21 outpatients with at least three visits for DJD and who were aware of SDM.
Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations.
In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
退行性关节疾病（DJD）有多种治疗选择。在临床就诊时，患者和临床医生共同决定 DJD 的最佳治疗方案；这就是共同决策（SDM）的本质。在这里，我们整理和评估了台湾 DJD 门诊患者的 SDM 相关经验和观点。
深入访谈和主题分析。
台湾一家地区教学医院的基层诊所，2021 年 10 月至 2022 年 5 月。
21 名至少就诊 3 次且了解 SDM 的 DJD 门诊患者。
本研究出现了四个主要主题：第一，充实自己的知识：患者通过各种方式获得疾病相关和治疗相关知识——在线搜索相关信息、与家人和朋友讨论、从自己的经验中学习或向专业人士学习。第二，共享或不共享：医生与患者沟通的模式不同，特别是在表现出权威、进行相互讨论、尊重患者偏好或敷衍了事时。第三，就诊时很少对医生开的治疗方案说不：大多数患者尊重医生的专业精神；然而，有些患者间接地拒绝了医生的建议，而有些患者则根据自己的疾病预后做出回应。第四，听谁的？-患者独立或与家人讨论或听从医生的建议来决定接受或拒绝治疗方案。
一般来说，DJD 患者在就诊前会从各种来源寻找可靠的医疗信息；然而，在与患者交谈时，医生主导了治疗方案的讨论。SDM 过程中患者-医生互动的动态决定了最终的医疗决策，这符合患者最初的自主权或医生的建议。为了减轻医疗家长主义和医生主导的情况，应该赋予患者参与医疗决策的权力，并与医生分享他们的意见或担忧。家庭成员也应包括在 SDM 中。
