对患者共同决策程度差异的解释进行了范围审查
Anne C Zagt1, Nanne Bos1, Max Bakker1
1Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
Patient education and counseling
|October 28, 2023
概括
了解共享决策 (SDM) 需要探索超越患者和医生的因素. 本综述确定了影响患者参与医疗保健决策的微,中和宏观层次解释.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 以患者为中心的护理
- 医疗决策的制定 医疗决策的制定
背景情况:
- 共享决策 (SDM) 对于以患者为中心的护理至关重要.
- 患者所经历的SDM程度的变化需要了解潜在的解释.
- 以前的研究主要集中在微观层面的因素上.
研究的目的:
- 对文献进行全面的范围审查,以确定患者经历的SDM程度差异的解释.
- 将这些解释分类为不同的影响水平 (微,中,宏).
- 为提高SDM在临床实践中的策略提供信息.
主要方法:
- 对21,329个参考进行了系统范围审查.
- 在最终分析中包括了308项研究.
- 对SDM差异的解释被分为微,中,宏等级.
主要成果:
- 解释主要来自微观层面,涉及患者,医疗保健专业人员,患者与医生的关系和家庭参与.
- 宏观层面的因素包括医疗保健系统的限制,如时间和信息的可用性.
- 中级因素包括护理连续性和专业间的协作.
结论:
- SDM是一个复杂的过程,受多个层面的因素的影响,而不仅仅是患者与医生的互动.
- 对SDM变化的解释在微,中和宏观层面之间相互连接.
- 未来的努力应优先考虑宏观和中级因素及其相互关系,以改善SDM.
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