期刊
PATIENT EDUCATION AND COUNSELING
卷 98, 期 10, 页码 1172-1179出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.pec.2015.06.022
关键词
Shared decision making; Physician-patient communication; Medical ethics; Patient preferences; Deliberation
Objective: Shared decision-making (SDM) is advocated as the model for decision-making in preference-sensitive decisions. In this paper we sketch the history of the concept of SDM, evidence on the occurrence of the steps in daily practice, and provide a clinical audience with communication strategies to support the steps involved. Finally, we discuss ways to improve the implementation of SDM. Results: The plea for SDM originated almost simultaneously in medical ethics and health services reseatch. Four steps can be distinguished: (1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient's wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent. Discussion: Knowledge and awareness among both professionals and patients as well as tools and skills training are needed for SDM to become widely implemented. Practice Implications: Professionals may use the steps and accompanying communication strategies to implement SDM. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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