患者和临床医生在预防性医疗保健决策和美国预防性服务工作组建议中的合作和共同决策
, Karina W Davidson1, Carol M Mangione2
1Feinstein Institutes for Medical Research at Northwell Health, New York, New York.
JAMA
|March 22, 2022
概括
共享决策 (SDM) 对于以患者为中心的预防护理至关重要,使USPSTF的建议与个体患者的价值观保持一致. 需要进一步的研究来探索SDM在减少健康不平等和优化初级保健讨论中的作用.
科学领域:
- 公共卫生
- 医疗服务研究
- 临床决策
背景情况:
- 美国预防服务工作组 (USPSTF) 提供基于证据的预防服务建议.
- 患者为中心的护理是美国医疗保健的基本原则.
- 分享决策 (SDM) 涉及患者和临床医生在健康决策上进行合作.
研究的目的:
- 审查SDM在USPSTF建议中的作用.
- 突出SDM如何支持患者参与和以患者为中心的预防性护理.
- 确定关于SDM对健康公平和初级保健的影响的未来研究领域.
主要方法:
- 对USPSTF建议类别的分析 (A,B,C,D,I声明).
- 审查以患者为中心的护理和共同决策的原则.
- 讨论SDM对不同水平的证据和益处的影响.
主要成果:
- 患者将A或B建议与个人价值观结合起来非常重要.
- SDM对于患者来说至关重要,以确定C建议的净益处是否值得.
- 临床医生应准备好讨论D建议或I陈述,如果患者询问.
结论:
- SDM是以以患者为中心的方式实施USPSTF建议的组成部分.
- 需要进一步的证据来确定SDM在减少健康不平等方面的有效性.
- 需要新的策略将SDM讨论纳入初级保健工作流程.
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