Landry Joshua T
Southlake Health, Newmarket, Canada.
Health Care Anal. 2025 May 20. doi: 10.1007/s10728-025-00524-3.
Shared decision-making ("SDM") has increased in acceptance and become a gold standard in medical decision-making over the last two decades. Despite this, there continues to be disagreement about several facets of SDM that many existing models or versions do not sufficiently address, including: that there is a lack of agreement about which version or model of SDM to utilize in practice; that there are practical limitations on when SDM ought to be utilized; that SDM may be required to use different "harm thresholds" when making decisions for patients who have lost decision-making capacity or competence, or for those who have never had such capacity in the first place; and that many existing models of SDM succumb to what is known as the "framing problem," among other concerns. Elsewhere, this author presented a model of SDM titled, the Professionally-Driven Zone of Patient or Surrogate Discretion (or, Professionally-Driven ZPSD) as a more comprehensive and defensible way forward. This article sets out to expand on the expected benefits of the model, and apply it to several case studies in the acute-care setting in order to demonstrate its functionality as a model of SDM.
在过去二十年中，共同决策（“SDM”）的认可度有所提高，并已成为医疗决策中的黄金标准。尽管如此，关于SDM的几个方面仍存在分歧，许多现有模型或版本并未充分解决这些问题，包括：在实践中应采用哪种SDM版本或模型缺乏共识；SDM在何时应用存在实际限制；在为失去决策能力或从未具备决策能力的患者做决策时，可能需要使用不同的“伤害阈值”；以及许多现有的SDM模型都存在所谓的“框架问题”等问题。在其他地方，本文作者提出了一种名为“专业驱动的患者或代理人自由裁量区域”（或“专业驱动的ZPSD”）的SDM模型，作为一种更全面且更具说服力的前进方向。本文旨在详述该模型的预期益处，并将其应用于急性护理环境中的几个案例研究，以展示其作为SDM模型的功能。
