Gurtner Caroline, Schols Jos M G A, Lohrmann Christa, Hahn Sabine
Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
PEC Innov. 2024 Oct 21;5:100352. doi: 10.1016/j.pecinn.2024.100352. eCollection 2024 Dec 15.
Shared decision-making is one promising approach to promoting recovery and person-centred care but seems challenging for implementation in clinical practice. This study aimed to explore how patients and health professionals experience shared decision-making and its facilitators and barriers.
A multiple qualitative case study design was chosen, using a constant comparative method. Multiple data sources were used, including individual interviews, observation, document analysis and a focus group.
Through first a within-case analysis and then second a cross-case analysis, four patient profiles and their potential for shared decision-making were constructed. The results indicate that in the daily routine of the psychiatric inpatient setting different forms of decision making are used, even though health professionals advocate shared decision-making as the favored approach. Patients also have varying expectations and perceptions regarding shared decision-making, which is reflected in the degree of their involvement.
Shared decision-making could be enhanced in the future by a more proactive communication style and the proactive provision of information on the part of health professionals, in order to enhance patient participation in decision-making.
The study identified different forms of decision-making within the acute psychiatric inpatient setting, highlighting the gap between the advocated SDM approach and its practical implementation. This divergence is a key aspect, as it underlines the complexity of implementing SDM in real clinical settings.
共同决策是促进康复和以患者为中心的护理的一种有前景的方法，但在临床实践中实施起来似乎具有挑战性。本研究旨在探讨患者和卫生专业人员如何体验共同决策及其促进因素和障碍。
采用多案例定性研究设计，运用持续比较法。使用了多种数据来源，包括个人访谈、观察、文件分析和焦点小组。
首先通过个案内分析，然后通过跨案例分析，构建了四种患者概况及其共同决策的潜力。结果表明，在精神科住院患者的日常环境中，即使卫生专业人员提倡将共同决策作为首选方法，仍会使用不同形式的决策。患者对共同决策也有不同的期望和认知，这反映在他们的参与程度上。
未来可以通过更积极主动的沟通方式以及卫生专业人员主动提供信息来加强共同决策，以提高患者参与决策的程度。
该研究确定了急性精神科住院环境中不同形式的决策，突出了所提倡的共同决策方法与其实际实施之间的差距。这种差异是一个关键方面，因为它强调了在实际临床环境中实施共同决策的复杂性。
