Guadagnoli E, Ward P
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Soc Sci Med. 1998 Aug;47(3):329-39. doi: 10.1016/s0277-9536(98)00059-8.
We review the research both for and against patient participation in decision-making and conclude that (a) patients want to be informed of treatment alternatives, (b) they, in general, want to be involved in treatment decisions when more than one treatment alternative exists, and (c) the benefits of participation have not yet been clearly demonstrated in research studies. However, studies that have addressed the latter issue suffer from methodological problems such as small sample sizes and lack of control for potential confounding variables. We conclude that patient participation in decision-making is justified on humane grounds alone and that physicians should endeavor to engage patients in decision-making, albeit at varying degrees, when more than one effective treatment option exists. We propose that methods be developed to evaluate a patient's level of "readiness" to participate in decision-making and that interventions that match the patient's level of readiness be applied to increase participation.
我们回顾了支持和反对患者参与决策的研究，并得出以下结论：（a）患者希望了解治疗方案；（b）一般来说，当存在多种治疗方案时，他们希望参与治疗决策；（c）参与决策的益处尚未在研究中得到明确证明。然而，探讨后一个问题的研究存在方法学问题，如样本量小以及缺乏对潜在混杂变量的控制。我们得出结论，仅出于人道理由，患者参与决策就是合理的，并且当存在多种有效治疗选择时，医生应努力让患者参与决策，尽管程度不同。我们建议开发方法来评估患者参与决策的“准备程度”，并应用与患者准备程度相匹配的干预措施来提高参与度。
