Med Decis Making - Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions.

Tópicos

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{ intervent(3218) particip(2042) group(1664) }
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{ howev(809) still(633) remain(590) }
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{ record(1888) medic(1808) patient(1693) }
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{ implement(1333) system(1263) develop(1122) }
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{ research(1085) discuss(1038) issu(1018) }
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{ method(984) reconstruct(947) comput(926) }
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{ state(1844) use(1261) util(961) }
{ patient(2837) hospit(1953) medic(668) }
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{ data(2317) use(1299) case(1017) }
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{ signal(2180) analysi(812) frequenc(800) }
{ cost(1906) reduc(1198) effect(832) }
{ group(2977) signific(1463) compar(1072) }
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{ gene(2352) biolog(1181) express(1162) }
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{ first(2504) two(1366) second(1323) }
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{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ use(1733) differ(960) four(931) }
{ drug(1928) target(777) effect(648) }
{ result(1111) use(1088) new(759) }
{ estim(2440) model(1874) function(577) }
{ activ(1452) weight(1219) physic(1104) }
{ method(1969) cluster(1462) data(1082) }
{ method(2212) result(1239) propos(1039) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

This article provides an analysis of 'decision aids', interventions to support patients facing tough decisions. Interest has increased since the concept of shared decision making has become widely considered to be a means of achieving desirable clinical outcomes. We consider the aims of these interventions and examine assumptions about their use. We propose three categories, interventions that are used in face-to-face encounters, those designed for use outside clinical encounters and those which are mediated, using telephone or other communication media. We propose the following definition: decision support interventions help people think about choices they face; they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions help people to deliberate, independently or in collaboration with others, about options, by considering relevantattributes; they support people to forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help the process of constructing preferences and eventual decision making, appropriate to their individual situation. Although quality standards have been published for these interventions, we are also cautious about premature closure and consider that the need for short versions for use inside clinical encounters and long versions for external use requires further research. More work is also needed on the use of narrative formats and the translation of theory into practical designs. The interest in decision support interventions for patients heralds a transformation in clinical practice although many important areas remain unresolved.

Resumo Limpo

articl provid analysi decis aid intervent support patient face tough decis interest increas sinc concept share decis make becom wide consid mean achiev desir clinic outcom consid aim intervent examin assumpt use propos three categori intervent use facetofac encount design use outsid clinic encount mediat use telephon communic media propos follow definit decis support intervent help peopl think choic face describ choic exist provid inform option includ reason option take action intervent help peopl deliber independ collabor other option consid relevantattribut support peopl forecast might feel short intermedi longterm outcom relev consequ way help process construct prefer eventu decis make appropri individu situat although qualiti standard publish intervent also cautious prematur closur consid need short version use insid clinic encount long version extern use requir research work also need use narrat format translat theori practic design interest decis support intervent patient herald transform clinic practic although mani import area remain unresolv

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