Abstract：
For more than sixty years, surgeons have used bioethical strategies to promote patient self-determination, many of these now collectively described as \"informed consent.\" Yet the core framework-understanding, risks, benefits, and alternatives-fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will \"fix\" the problem. They omit critical information about the goals and downsides of surgery and present untenable options as a matter of patient choice. We propose a novel framework called \"better conversations.\" Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment.
摘要：
六十多年来,外科医生使用生物伦理策略来促进患者的自决，其中许多现在统称为“知情同意”。“然而，核心框架--理解，风险,好处,和替代方案-未能支持患者考虑治疗。我们发现，外科医生将这个框架转化为对疾病和治疗的过于复杂的技术解释，以及手术将“解决”问题的过于简化的叙述。他们忽略了有关手术目标和缺点的关键信息，并提出了站不住脚的选择作为患者选择的问题。我们提出了一个名为“更好的对话”的新框架。\"在这里，外科医生提供有关临床规范的背景，确立手术的目标，并全面描绘手术的缺点，为患者提供一个审议空间，让患者考虑手术是否适合他们。这种范式转变符合知情同意的标准，支持审议，并允许患者预测和准备治疗的经验。
