Deber R B
Department of Health Administration, University of Toronto, Ont.
CMAJ. 1994 Aug 15;151(4):423-7.
How reasonable are expectations that patients will participate in care decisions? The previous article in this series reviewed models of the patient-physician relationship and views on the extent to which patients want to be informed; it also described one information tool--the interactive videodisc. This article reviews literature on the extent to which patients wish to be involved in making decisions about their care. Neither "sensitive paternalism" nor "informed consent" appears to be ideal. The author suggests a distinction between two elements of choice: problem solving and decision making. This distinction helps in identifying appropriate roles for patient and provider, thereby leading to genuine shared decision making.
期望患者参与医疗决策的合理性究竟如何？本系列的上一篇文章回顾了医患关系的模式以及关于患者希望了解信息程度的观点；还介绍了一种信息工具——交互式录像光盘。本文回顾了有关患者希望参与其医疗决策程度的文献。“敏感家长式作风”和“知情同意”似乎都不理想。作者建议区分选择的两个要素：解决问题和决策。这种区分有助于确定患者和医疗服务提供者的适当角色，从而实现真正的共同决策。
