What Is Shared in Shared Decision Making? Complex Decisions When the Evidence Is Unclear

Medical Care Research and Review - Tập 70 Số 1_suppl - Trang 94S-112S - 2013
Ronald M. Epstein1, Robert Gramling1
1University of Rochester Medical Center, Rochester, NY USA

Tóm tắt

Patient involvement in decisions is central to patient-centered care. Yet many important decisions must be made in complex, ambiguous clinical situations in which all possible options cannot be known, evidence is inadequate to inform patients’ preferences fully, and/or patients are unclear about their desired level of involvement. In these situations, preferences are shaped by affect, framing, and “collaborative cognition” among clinicians, patients, and their families; thus, decisions are often relational, dynamic, iterative, provisional, and/or conditional. Clinicians can help patients achieve greater autonomy by engaging both intuitive and deliberative decision-making processes (“whole mind”) and involving others in exploring, clarifying, and co-constructing patients’ preferences (“shared mind”). Clinical and interpersonal relationships can promote effective decision making through developing a shared attentional focus, tailoring information, and identifying conditions under which provisional preferences might change. Information technology and health systems offer untapped potential to deepen the relationships and conversations within which decisions are made.

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Tài liệu tham khảo

10.3322/canjclin.55.3.164

10.1111/j.1525-1497.2006.00302.x

10.2307/2071781

10.1136/jamia.1998.0050257

10.1177/0002764205283807

10.1037/h0089471

10.1016/S0277-9536(96)00221-3

10.1016/S0277-9536(99)00145-8

10.1200/JCO.2003.05.057

10.1016/j.socscimed.2009.01.016

10.1016/S0090-4295(97)00254-9

10.1097/00001888-200308000-00003

Damasio A. R., 1994, Descartes’ error: Emotion, reason, and the human brain

10.1002/cncr.23543

10.1097/00005650-196805000-00001

Elwyn G., 2000, British Journal of General Practice, 50, 892

10.1111/j.1365-2753.2010.01517.x

10.1176/ajp.137.5.535

10.1007/s11606-010-1292-2

10.1001/jama.282.9.833

10.1001/jama.291.19.2359

10.1377/hlthaff.2009.0888

10.1001/jama.2009.984

10.1002/chp.149

10.1370/afm.1301

10.1146/annurev.psych.59.103006.093629

10.1111/j.1533-2500.2012.00573.x

10.1037/0003-066X.46.8.835

Fischhoff B., 2005, Handbook of environmental economics, 937

10.1017/CBO9780511810503

Gawande A., 2009, The checklist manifesto: How to get things right

Gigerenzer G., 2007, Gut feelings: The intelligence of the unconscious

Glouberman S., 2002, Complicated and complex systems: What would successful reform of Medicare look like?

10.1016/j.polsoc.2010.12.005

10.1016/j.pec.2009.09.020

10.1007/s11606-008-0719-5

Hesse B. W., 2005, Studies in Health Technology and Informatics, 118, 159

Institute of Medicine, 2001, Crossing the quality chasm: A new health system for the 21st century

10.7326/0003-4819-154-8-201104190-00007

James W., 1961, The varieties of religious experience: A study in human nature

10.1016/j.pec.2006.10.009

10.1037/0003-066X.58.9.697

Kinnersley P., 2007, Cochrane Database of Systematic Reviews, CD004565

10.1001/jama.2009.1384

Kreuter M., 2000, Tailoring health messages: Customizing communication with computer technology

10.1037/a0020762

10.1377/hlthaff.2009.0450

10.1017/CBO9780511618031

Lindblom C. E., 1958, American Economic Review, 48, 298

10.2307/973677

10.1111/j.1445-5994.2008.01700.x

McWhinney I. R., 1989, Family Medicine, 21, 296

10.1080/01650250143000283

10.2105/AJPH.2010.300014

10.1007/978-94-007-1682-7_10

10.1097/ACM.0b013e3181f073dd

Moulton C. A., 2007, Academic Medicine RIME: Proceedings of the Forty-Sixth Annual Conference, 82, S109, 10.1097/ACM.0b013e3181405a76

10.1177/0272989X07306780

Norman G., 2007, Medical Education, 41, 1140

O’Connor A. M., 2001, Cochrane Database of Systematic Reviews, CD001431

10.1080/10253890600965773

Polanyi M., 1983, The tacit dimension

10.1111/j.1365-2753.2010.01549.x

10.7326/0003-4819-151-5-200909010-00010

10.1001/jama.2011.1413

10.1111/j.1467-9566.2007.01064.x

10.1177/0272989X08327066

10.1001/jama.2010.1817

10.1001/jama.2010.1449

10.1037/0003-066X.50.5.364

10.1586/erp.12.3

10.1016/j.pec.2009.10.009

10.1001/jama.1984.03350210038026

10.1136/bmj.319.7212.766

Tresolini C., 1994, Health professions education and relationship-centered care: Report of the Pew-Fetzer Task Force on advancing psychosocial health education

10.1037/0278-6133.24.4.S57

10.1111/j.1525-1497.2004.30046.x

10.1177/0272989X07306113

Wilson T. D., 2010, Psychological Science, 14, 131

10.1002/cncr.21822

10.1075/celcr.12

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Medical Care Research and Review

Tập 70 Số 1_suppl

94S-112S

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