Pierce P F
University of Michigan, School of Nursing, Ann Arbor 48109, USA.
Hum Factors. 1996 Jun;38(2):278-87. doi: 10.1177/001872089606380208.
Patients make health care decisions in a complex and alien environment with little, if any, insightful aid from health care professionals; such professionals may be well intentioned but naive about how to provide decisional support. The search for information is unstructured, and once information is obtained, it is not easily understood by the layperson who may have difficulty understanding ambiguous and uncertain information. This paper addresses issues and concerns pertaining to the representation of unaided decision making in clinical practice among patients in two clinical contexts (breast cancer and cardiovascular disease). An analysis of qualitative clinical interviews provides indicators of naturalistic rule-based approaches patients use when making a medical decision. The relative salience of the alternatives plays a key role in discriminating rapid, intuitive decisions from those that are more deliberative. Empirical descriptions of real-world decision-making processes support a theoretical model of unaided decisions in health care.
患者在复杂且陌生的环境中做出医疗保健决策，几乎得不到（即便有也极少）医疗保健专业人员有见地的帮助；这些专业人员可能是出于好意，但对于如何提供决策支持却很天真。信息搜索是无组织的，而且一旦获得信息，外行人可能难以理解，因为他们可能难以理解模糊和不确定的信息。本文探讨了在两种临床情境（乳腺癌和心血管疾病）中患者在临床实践中自主决策的相关问题和担忧。对定性临床访谈的分析提供了患者在做出医疗决策时使用的基于自然规则方法的指标。备选方案的相对显著性在区分快速、直观的决策和更具深思熟虑的决策方面起着关键作用。对现实世界决策过程的实证描述支持了医疗保健中自主决策的理论模型。
