Charles C, Gafni A, Whelan T
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Soc Sci Med. 1997 Mar;44(5):681-92. doi: 10.1016/s0277-9536(96)00221-3.
Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.
共同决策越来越多地被倡导为医疗过程中治疗决策的理想模式。迄今为止，这一概念的定义相当模糊且不严谨。本文试图更清晰地阐述共同治疗决策的概念，确定该模式的一些关键特征，并讨论衡量问题。我们关注的特定决策背景是潜在的危及生命的疾病，在疾病过程的关键点上需要做出重要决策，并且存在几种治疗选择，其可能结果不同且存在很大的不确定性。我们认为共同决策的关键特征包括：（1）至少有两名参与者——医生和患者参与；（2）双方共享信息；（3）双方采取措施就首选治疗达成共识；（4）就实施的治疗达成协议。本文还讨论了衡量共同决策的一些挑战以及共同决策模式对医生和患者双方的潜在益处。
