超越偏好:通过护理的镜头重新思考共享决策
Mauro Turrini1, Roberta Valenti2, Jeanette Bresson Ladegaard Knox3
1Instituto de Políticas y Bienes Públicos (IPP), Consejo Superior de Investigaciones Científicas (CSIC), Spain.
Social science & medicine (1982)
|December 13, 2025
概括
共享决策 (SDM) 往往忽视了患者护理动态. 这项研究表明,患者代理权是一种定位谈判,而不仅仅是偏好表达,要求在医疗保健中做出更积极的参与.
科学领域:
- 医学社会学 医学社会学
- 健康 人文 卫生 人文
- 以患者为中心的护理
背景情况:
- 共享决策 (SDM) 是现代医疗保健的基石,强调通过偏好表达患者参与.
- 当前的SDM模式往往优先考虑理性审议,可能忽视护理的关系和情感方面.
研究的目的:
- 检查接受长期抗凝药治疗的患者如何做出决策和感知他们的治疗.
- 在SDM框架内批判性地分析患者"偏好"的概念.
- 探索超越理性选择的患者代理的替代模型.
主要方法:
- 在法国,西班牙和丹麦进行的民族学实地调查.
- 这项研究的重点是患者有史以来未引起的静脉血栓栓塞 (VTE) 在长期抗凝药治疗.
- 根据安妮玛丽·莫尔 (Annemarie Mol) 的"护理逻辑"框架进行分析.
主要成果:
- 患者的"偏好"不是固定的,而是脆弱的,偶然的,以及由背景塑造的突发反应.
- 医生对偏好的解释可能会掩盖其他形式的患者代理.
- 患者的代理权是通过持续的治疗谈判来行使的,这种谈判超出了临床咨询的范围.
结论:
- 一种"护理逻辑"的方法揭示了患者的代理作为持续的谈判,而不仅仅是预先定义的选项之间的选择.
- 专注于护理而不是选择,可以更好地响应患者的需求,要求和犹.
- 医疗保健的参与应该超出偏好表达范围,以拥抱更敏感的参与形式.
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