需要解决的问题在哪里? 在共享决策中的问题定义和认识不确定性
1Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong Special Administrative Region of China.
医生和患者使用不同的知识来定义癌症治疗问题. 了解这些根植于社会和个人系统的独特观点,可以通过叙事交流改善共享决策.
科学领域:
- 在瘤学瘤学.
- 医学社会学 医学社会学
- 卫生沟通健康沟通
背景情况:
- 医生和患者拥有不同的,但重叠的知识基础,影响癌症治疗问题定义.
- 不同的问题定义源于在癌症护理过程中不同的上下文知识应用.
研究的目的:
- 确定医生和患者在癌症治疗共享决策中定义问题时使用的知识来源.
- 在癌症治疗期间,调查医生-病人双边关系中不同问题的定义的起源.
主要方法:
- 采用了分裂的叙事方法.
- 对32名癌症患者和来自中国西北部两家领先医院的16名医生进行了采访.
主要成果:
- 医生的问题定义是由社会系统中的五种类型的知识来源构成的.
- 患者的问题定义是基于个人系统中的五种类型的知识来源.
- 非对称的社会机制是知识利用问题的基础,突出结构和文化障碍.
结论:
- 相互理解和信任受到问题定义中不对称的知识应用的挑战.
- 共享的问题定义可以从医生与患者互动中固有的认识不确定性中出现.
- 在多个层面 (宏观,中等,微观) 的叙事交流为共享决策中发现的问题提供了潜在的解决方案.
- 医生应该考虑患者的文化叙述,而患者应该在共同决策中承认医生的社会结构观点.
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