Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
Patient Educ Couns. 2024 Jul;124:108284. doi: 10.1016/j.pec.2024.108284. Epub 2024 Mar 30.
To construct the underlying value structure of shared decision making (SDM) models.
We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations.
We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism].
SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction.
This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
构建共享决策（SDM）模型的潜在价值结构。
我们纳入了先前确定的 SDM 模型（n=40）和另外 15 个模型。使用主题分析，我们使用 Schwartz 的价值观理论对数据进行编码，以确定 SDM 中的价值观并研究价值观关系。
我们确定并定义了八个价值观，并基于它们的关系开发了三个主题：共同控制、安全和支持性的环境以及针对患者的决策。我们基于价值关系和主题构建了一个价值结构：医疗保健专业人员（HCPs）和患者技能的相互作用[成就]、对患者的支持[仁慈]以及 HCP 和患者之间的良好关系[安全]都促进了患者的自主性[自我导向]。这些价值观使 HCP 和患者之间的关系更加平衡，并实现了量身定制的决策[普遍主义]。
SDM 可以通过价值观的相互作用来实现。仁慈和安全这两个价值观值得更明确的关注，并且可能特别增加弱势患者的自我导向。
该价值结构使我们能够将 SDM 背后的价值观与特定人群的价值观进行比较，从而将患者的价值观纳入治疗决策。它还可以为 SDM 措施、干预、教育计划的制定以及 HCP 在实践中的应用提供信息。
