Shared decision-making Dotaz Zobrazit nápovědu
Spolurozhodování (shared decision making, SDM) je strategie, která zahrnuje pacienta do rozhodování o jeho léčbě. V oblasti somatické medicíny je spolurozhodování o léčbě zkoumáno a více či méně aplikováno již delší dobu. Její užití v psychiatrii je v počátcích a očekává se od ní zlepšení adherence k léčbě a prognózy. Nejvíce prací z této oblasti pochází od německých autorů, kteří prokázali její uskutečnitelnost a potenciální výhody jak v akutní, tak dlouhodobé léčbě poruch schizofrenního okruhu. SDM také představuje jeden z důležitých aspektů individualizovaného přístupu k pacientovi.
Shared decision making (SDM) is a strategy for including patients in therapeutic decision processes In the somatic medicine the SDM has been studied and used for several years now. The application of shared decision making to psychiatry is still in the initial stage. The use of this strategy is expected to improve long-term compliance and outcome. Most studies has been done by German authors which have proved its feasibility and potential advantages in both acute and long-term treatment in schizophrenia. The SDM represents one of the important aspects dealing with individualized approach to the patient.
- Klíčová slova
- Spolurozhodování o léčbě (shared decision making, SDM),
- MeSH
- adherence k farmakoterapii MeSH
- adherence pacienta * psychologie MeSH
- individualizovaná medicína metody trendy využití MeSH
- lékařská etika MeSH
- lidé MeSH
- lidská práva trendy zákonodárství a právo MeSH
- osobní autonomie MeSH
- prognóza MeSH
- schizofrenie * farmakoterapie terapie MeSH
- terapie * metody využití MeSH
- zákonodárství lékařské MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
- MeSH
- komunikace MeSH
- lidé MeSH
- mladiství MeSH
- neinvazivní ventilace MeSH
- neuromuskulární nemoci komplikace MeSH
- obstrukční spánková apnoe terapie MeSH
- paliativní péče MeSH
- sdílené rozhodování * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVE: Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. METHODS: We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. RESULTS: We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. CONCLUSION: Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.
- MeSH
- cévní mozková příhoda * prevence a kontrola MeSH
- fibrilace síní * komplikace MeSH
- lidé MeSH
- metody pro podporu rozhodování MeSH
- rozhodování MeSH
- sdílené rozhodování MeSH
- zapojení pacienta MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
- MeSH
- fatální výsledek MeSH
- hospicová a paliativní ošetřovatelská péče MeSH
- informování rodičů MeSH
- kojenec MeSH
- lidé MeSH
- odmítnutí terapie pacientem * MeSH
- primární hyperoxalurie komplikace terapie MeSH
- prognóza MeSH
- progrese nemoci MeSH
- renální insuficience etiologie MeSH
- sdílené rozhodování * MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. METHODS: We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style - Staff questionnaire and a set of questions regarding clinicians' expertise, training, and practice. RESULTS: SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. CONCLUSIONS: The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.
- MeSH
- klinické rozhodování MeSH
- lidé MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- psychiatrie * MeSH
- rozhodování MeSH
- zapojení pacienta * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
V roce 2012 (s následnou aktualizací v roce 2015) publikovala Evropská liga proti revmatismu doporučení přístupu k péči o pacienty s psoriatickou artritidou ve snaze zajistit optimální standardizovanou péči o pacienty s tímto onemocněním založenou na důkazech. Jedním z hlavních předpokladů této standardizované péče je sdílené rozhodování pacienta a lékaře o všech aspektech této komplexní nemoci, což si vyžádá zevrubné informování nemocného. Tento článek se zabývá významem sdíleného rozhodování pro zlepšení spolupráce pacienta a lékaře, adherence k léčbě a schopností udělat informované rozhodnutí.
In 2012, the European League against Rheumatism published recommendations for the management of psoriatic arthritis patient care in an effort to ensure optimal, standardized, evidence‑based care. In 2015, an update of these recommendations was published. One of the main assumptions for this standardized care is the shared decision between the patient and physician on all aspects of this comprehensive disease, which requires detailed information about the patient and his or her awareness about the complexity of the disease. This article discusses the importance of shared decision‑making for the improvement of patient‑physician collaboration, adherence to treatment, and the ability to make informed decisions.
- MeSH
- adherence a compliance při léčbě MeSH
- lidé MeSH
- management nemoci MeSH
- motivace MeSH
- psoriatická artritida * diagnóza psychologie terapie MeSH
- sdílené rozhodování * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Making decisions about health care issues in advanced illness is difficult and the participation of patients and relatives is essential. Most of the studies on shared decision-making focus on the interaction between patient and physician (dyadic interaction), while the role of relatives in triadic decision-making remains less explored. The aim of the study was to investigate the perceived importance of the role of the patient, the physician and the relative in the decision-making from their respective perspectives. METHODS: Patients (n=154) with advanced disease, their relatives (n=95) and physicians (n=108) were asked to rank the importance of their roles on the scale from 0 to 10. Differences between respondent groups were examined by ANOVA. A typology of answers was constructed for dyadic and triadic relations and analyzed by descriptive statistics and the chi-square test. RESULTS: Physicians rated the importance of patients' role in decision-making significantly higher [mean 9.31; 95% confidence interval (CI): 9.07-9.55] than did patients themselves (mean 7.85; 95% CI: 7.37-8.32), while patients and relatives rated higher the importance of the physicians' role (mean 9.29; 95% CI: 8.98-9.59 and mean 9.20; 95% CI: 8.96-9.45, respectively) than did physicians themselves (mean 8.35; 95% CI: 0.06-8.65). In the analysis of the patient-physician dyadic interaction, patients ranked their role as equally important (44.1%) or more important (11.2%) than the role of physicians. Physicians (56.5%) thought patients should play a more important role. When relatives were included in the analysis, patients either preferred equal role of the three actors (30.2%) or prioritized the role of the physician and the relatives (16.8%), while physicians and relatives prioritized the role of the patient (54.6% and 29.0%, respectively). All results were statistically significant (P<0.05). CONCLUSIONS: Physicians and relatives tend to accentuate the active role of patients, while patients mostly prefer shared decision-making. Physicians seem to underestimate the importance of the role of relatives, compared to patients and relatives for whom the participation of relatives in the decision-making is of greater importance. A triadic decision-making model that acknowledges the importance of all three actors should be implemented in decision-making process in advanced illness.
- MeSH
- chronická nemoc MeSH
- lékaři * MeSH
- lidé MeSH
- rozhodování MeSH
- vztahy mezi lékařem a pacientem MeSH
- zapojení pacienta * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
