数字时代知情同意与共同决策的全球考虑因素

IF 9 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL BMJ Evidence-Based Medicine Pub Date : 2024-05-02 DOI:10.1136/bmjebm-2023-112740
Edward Robert St John, Connor James Stewart Moore, Raghu Ram Pillarisetti, Erica Sarah Spatz
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引用次数: 0

摘要

共同决策(SDM)被越来越多的人认为是以患者为中心的医疗服务的基础,它使患者能够在知情的情况下对自己的健康做出自愿的决定。患者是自己的专家,了解自己的偏好和对风险的态度。临床医生是医学知识和科学证据方面的专家。应共同探讨治疗方案,做出适合患者并得到临床医生支持的治疗决定。在处理侵入性或高风险程序(如手术、化疗、放疗、免疫疗法)时,一旦做出治疗决定,谈话就会转向知情同意。这是一个就手术的潜在风险和益处进行沟通并达成一致的过程,同时承认还有其他治疗方案未被选择。虽然知情同意应该是 SDM 的高潮,但它并不能概括整个过程。决策和同意之间是有区别的,理想的情况下,决策和同意之间应该有一段反思的时间。尽管 SDM 取得了进步,但随后的知情同意程序仍停滞不前,往往不符合支持患者有意义的自主权的伦理或法律标准。2 在现实中,可能需要快速做出手术决定(如急诊或癌症路径),在这种情况下,时间是提供最佳患者护理的宝贵财富。在这些情况下,从诊断到治疗方案再到同意的讨论通常会很快进行。然而,临床医生时间有限不应成为同意不充分的借口。因此,在数字时代重新构想同意程序,确保尽早清晰、正确地介绍治疗方案的益处、风险和替代方案,能够将这一步骤从仪式化的姿态转变为...
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Global considerations for informed consent with shared decision-making in the digital age
Shared decision-making (SDM) is increasingly recognised as fundamental to patient-centred care and enabling patients to make voluntary, informed decisions about their health.1 SDM is the process whereby patients and clinicians come together to share their expertise. The patient acts as an expert of themselves, understanding their own preferences and their attitudes to risk. The clinician is an expert on the medical knowledge and scientific evidence. Together, treatment options should be explored, arriving at a treatment decision that is right for the patient and supported by the clinician. When dealing with invasive or high-risk procedures (eg, operations, chemotherapy, radiotherapy, immunotherapy), once the treatment decision has been made, the conversation turns to informed consent. This is the process of communicating and agreeing to the potential risks and benefits of the procedure, while acknowledging that there are alternative treatment options that have not been chosen. Though informed consent should be the culmination of SDM, alone it does not encapsulate the entire process. There is a distinction between decision-making and consent and this should ideally be accompanied by a period for reflection. Despite advances in SDM, the subsequent informed consent process has remained stagnant, often failing to meet ethical or legal standards of supporting meaningful patient autonomy.2 In reality, rapid surgical decisions may be required (e.g. emergency or cancer pathways), where time is a precious commodity to deliver optimal patient care. In these scenarios, it is common for discussions to move quickly from diagnosis to treatment options, to consent. However, scarcity of clinician time should not be an excuse for inadequate consent. Therefore, reimagining the consent process in the digital age by ensuring the benefits, risks and alternative treatment options are clearly and correctly presented as early as possible, has the ability of transforming this step from a ritualised gesture into a …
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来源期刊
BMJ Evidence-Based Medicine
BMJ Evidence-Based Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
8.90
自引率
3.40%
发文量
48
期刊介绍: BMJ Evidence-Based Medicine (BMJ EBM) publishes original evidence-based research, insights and opinions on what matters for health care. We focus on the tools, methods, and concepts that are basic and central to practising evidence-based medicine and deliver relevant, trustworthy and impactful evidence. BMJ EBM is a Plan S compliant Transformative Journal and adheres to the highest possible industry standards for editorial policies and publication ethics.
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