PDF(Pubmed)
Abstract：
OBJECTIVE: Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan.
METHODS: In-depth interviews and thematic analysis.
METHODS: Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022.
METHODS: 21 outpatients with at least three visits for DJD and who were aware of SDM.
RESULTS: Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians\' professionalism; however, some patients rejected physicians\' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians\' recommendations.
CONCLUSIONS: In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients\' original autonomy or physicians\' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
METHODS: In-depth interviews and thematic analysis.
METHODS: Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022.
METHODS: 21 outpatients with at least three visits for DJD and who were aware of SDM.
RESULTS: Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians\' professionalism; however, some patients rejected physicians\' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians\' recommendations.
CONCLUSIONS: In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients\' original autonomy or physicians\' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
摘要：
目的：对于退行性关节病（DJD）有多种治疗选择。在临床就诊期间，患者和临床医生共同做出关于DJD的最佳治疗的决策;这是共享决策(SDM)的本质。这里,我们整理并评估了台湾DJD门诊患者的SDM相关经验和观点。
方法：深入访谈和主题分析。
方法：台湾某地区教学医院的初级保健诊所，2021年10月-2022年5月。
方法：21名门诊患者至少3次就诊于DJD，且了解SDM。
结果：这项研究中出现了四个主要主题：第一，掌握知识:门诊患者以各种方式获得疾病相关和治疗相关知识-在线查找相关信息，与家人和朋友讨论，从自己的经验中学习或向专业人士学习。第二,共享或不共享：医生与患者沟通有不同的模式，特别是在展示权威时，进行相互讨论，尊重病人的喜好或敷衍了事。第三，在临床就诊时很少对医生规定的治疗计划说不:大多数患者尊重医生的专业精神；然而，一些患者间接拒绝了医生的建议，而有些反应取决于他们的疾病预后。第四，谁的电话？参与者决定独立接受或拒绝治疗计划，或通过与家人讨论或服从医生的建议。
结论：一般来说，DJD患者在去看医生之前从各种来源寻求可靠的医疗信息；但是，当与病人交谈时，内科医生主导了关于治疗方案的讨论.SDM过程中的患者-医师互动动态决定了最终的医疗决策。这符合患者的“原始自主权”或医生的建议。为了减轻医疗家长制和医生主导，患者应有权参与医疗决策，并与医生分享他们的意见或疑虑。家庭成员也应包括在SDM中。
方法：深入访谈和主题分析。
方法：台湾某地区教学医院的初级保健诊所，2021年10月-2022年5月。
方法：21名门诊患者至少3次就诊于DJD，且了解SDM。
结果：这项研究中出现了四个主要主题：第一，掌握知识:门诊患者以各种方式获得疾病相关和治疗相关知识-在线查找相关信息，与家人和朋友讨论，从自己的经验中学习或向专业人士学习。第二,共享或不共享：医生与患者沟通有不同的模式，特别是在展示权威时，进行相互讨论，尊重病人的喜好或敷衍了事。第三，在临床就诊时很少对医生规定的治疗计划说不:大多数患者尊重医生的专业精神；然而，一些患者间接拒绝了医生的建议，而有些反应取决于他们的疾病预后。第四，谁的电话？参与者决定独立接受或拒绝治疗计划，或通过与家人讨论或服从医生的建议。
结论：一般来说，DJD患者在去看医生之前从各种来源寻求可靠的医疗信息；但是，当与病人交谈时，内科医生主导了关于治疗方案的讨论.SDM过程中的患者-医师互动动态决定了最终的医疗决策。这符合患者的“原始自主权”或医生的建议。为了减轻医疗家长制和医生主导，患者应有权参与医疗决策，并与医生分享他们的意见或疑虑。家庭成员也应包括在SDM中。
