手术共享决策研究现状及展望  

Research Status and the Prospect of Shared Decision-making in Surgery

作　　者：刘婷[1] 王冉 王林[1] 陈曦[1] 韩斌如[1] Liu Ting;Wang Ran;Wang Lin;Chen Xi;Han Binru(Xuanwu Hospital Capital Medical University,Beijing,100053;不详)

机构地区：[1]首都医科大学宣武医院,北京市100053

出　　处：《中国病案》2023年第1期18-21,共4页Chinese Medical Record

摘　　要：手术共享决策模式作为循证医学背景下一种新型的医学决策模式,以患者的价值观为基础,以家庭为中心,基于临床证据总结制定最佳的手术治疗和围手术期护理方案,为患者确定基于自身价值的健康结局提供了一种新的决策手段。手术患者期待共享决策主观意愿度高,但在真正实施推广手术共享决策时受到客观决策情境和主观决策主体综合影响,我国对手术共享决策关注度和实施率较低。医务人员性格特征营造的就医氛围影响手术患者SDM的实施,年轻、文化程度高和非首次手术是患者实际参与手术SDM的独立影响因素,患者对最佳决策的不确定性是手术SDM最主要的障碍因素,种族对手术SDM参与影响存在分歧。应从医护人员协作式管理患者、构建治疗性沟通策略、关注患者期望的决策内容、借助决策辅助工具、完善围术期SDM相关培训五个方面优化手术共享决策实施,为推动我国手术共享决策的开展提供参考依据。As a new type of medical decision-making model under the background of evidence-based medicine, the shared decision-making model for surgery is based on the patient’s values and is family-centered. It developed optimal surgical treatment and perioperative care plans based on summarizing clinical evidence and provides a new decision-making tool for patients to determine self-worth-based health outcomes. Surgical patients have a high degree of subjective willingness to expect shared decision-making, but the actual implementation of shared decision-making is affected by the combination of objective decision-making situations and subjective decision-making subjects.In our country, the attention and implementation rate of shared decision-making in surgery are relatively low. The medical atmosphere created by the personality characteristics of medical staff affects the implementation of SDM in surgical patients. Young age, high education level, and non-first-time surgery are independent influencing factors of patients’ actual participation in surgical SDM.Patient uncertainty about the best decision is the main obstacle to surgical SDM. There is disagreement over the impact of race on surgical SDM participation.The implementation of shared surgical decision-making should be optimized from five aspects:collaborative management of patients by medical staff, construction of therapeutic communication strategies,attention to decision-making content expected by patients, use of decision-making aids, and improvement of perioperative SDM-related training. These optimization aspects can provide a reference for promoting the development of shared decision-making in our country.

关 键 词：共享决策 手术 决策辅助 患者参与 

分 类 号：R197.323[医药卫生—卫生事业管理]