参加型意思決定のための証拠を伝える.
Ronald M Epstein1, Brian S Alper, Timothy E Quill
1Rochester Center to Improve Communication in Health Care, Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, USA. ronald_epstein@urmc.rochester.edu
JAMA
|May 20, 2004
まとめ
臨床的証拠の効果的なコミュニケーションは,患者の情報に基づいた意思決定に不可欠です. このレビューでは,限られた証拠にもかかわらず,患者の理解と関与を改善するための方法を強調し,共有された意思決定と明確なコミュニケーション戦略を強調しています.
科学分野:
- 医療コミュニケーションについて
- 健康に関する識字能力
- 患者との関わり合い
背景:
- 情報のある患者はケアに積極的に参加し,より良い意思決定と治療の遵守につながります.
- 現在,臨床的証拠を患者と議論するための根拠に基づいたガイドラインが不足しています.
- 効果的な患者と臨床医のコミュニケーションは,共同の医療意思決定に不可欠です.
研究 の 目的:
- 臨床的証拠を患者に伝えるための効果的な方法を特定する.
- 患者の理解,医療意思決定への関与,および健康上の成果を高めるために.
- 患者と臨床医のコミュニケーションにおいて,証拠に基づいたガイドラインの必要性を解決する.
主な方法:
- MEDLINE (1966-2003) の体系的なレビューと参考リスト.
- 臨床医と患者のコミュニケーションに関するオリジナルの研究を検索し,臨床的証拠を提示しました.
- 367件の要約をスクリーニングし,51件の全文記事をレビューし,8件の関連する研究を特定しました.
主要な成果:
- コミュニケーション方法には,一般的な用語,数値データ,グラフ,意思決定支援が含まれます.
- 意思決定の役割の前にオプションを提示し,絶対リスクを使用することが好ましい.
- 情報の順序,時間枠,患者の人口統計 (年齢,教育) は理解に影響します.
結論:
- 臨床的証拠を共有する際に医師を導くための証拠が著しく欠けている.
- 推奨事項は,患者の状況を理解し,パートナーシップを構築し,不確実性を議論することに焦点を当てています.
- 重要なコミュニケーションのタスクには,バランスの取れた証拠の提供,情報に基づいた勧告,理解の確認が含まれます.
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