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在儿科神经肌肉脊柱病中,人们对共享决策的看法有所不同
Jody L Lin1, Angela Zhu1, Marla L Clayman2,3
1Division of Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
MDM policy & practice
|February 26, 2026
概括
在儿科神经肌肉脊柱病护理中,共享决策 (SDM) 的质量往往是不够的. 提供者需要更好地引出母值,并评估决策的自我有效性,以改善结果.
科学领域:
- 儿科整形外科 儿科整形外科
- 医疗保健服务研究 医疗服务研究
- 以患者为中心的护理
背景情况:
- 共享决策 (SDM) 对患有医疗复杂性的儿童至关重要,但其质量尚不清楚.
- 在儿科骨科环境中评估SDM质量至关重要,特别是在神经肌肉脊柱病 (NMS) 手术决策方面.
研究的目的:
- 评估SDM在儿科NMS手术治疗决策中的质量,使用基于观察者和自我报告的措施.
- 确定SDM在儿科骨科护理中可以改进的具体领域.
主要方法:
- 18名患有NMS的儿童,他们的护理人员和3名脊椎外科医生参与了这项研究.
- 访问被视频录制并使用DEEP-SDM编码方案进行分析.
- 家长 (SDM-Q-9) 和提供者 (SDM-Q-Doc) 调查评估了SDM质量;计算了评价者之间的可靠性.
主要成果:
- 在18个儿童护理人员提供者三元组中,只有1个符合DEEP-SDM的所有标准.
- 讨论通常包括治疗的合理性和提供者偏好,但很少评估患者的自我有效性或定义所有选择.
- 虽然调查得分表明SDM质量中等至高,但关键SDM元素的可靠性差,表明存在重大差距.
结论:
- 提供者应加强对母体偏好/价值的诱导,以及在NMS治疗决策中对决策自我有效性的评估.
- 目前的SDM措施可能会高估质量,强调需要更强大的评估和改进的临床实践.
- 改善SDM对于优化医疗复杂性的儿童的护理至关重要.
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