目的:本研究使用创新扩散(DOI)理论来全面了解临床实践中共享决策(SDM)的采用,特别关注DOI内的“知识”和“说服”阶段。我们的目标是了解与采用SDM相关的挑战和动态。为医疗保健中更多以患者为中心的决策提供见解。
方法:这项定性研究采用了改进的框架分析方法,整合先前研究中的人种学和访谈数据,还有额外的采访。所使用的框架基于DOI理论。
方法:本研究在荷兰东部地区一家三级教学医院的妇产科进行。它包括对20名参与者的采访,包括妇科医生,目前在该部门执业的产科注册会计师和初级医生。此外,合并了在同一部门内进行的先前研究的数据,确保上下文的一致性。
结果:研究结果揭示了SDM的优势和挑战之间复杂的相互作用。临床医生重视SDM维护患者自主性和加强医疗实践,认为它对医疗决策有价值。决策辅助在支持治疗决策方面被视为有利的。挑战包括患者和临床医生偏好之间的兼容性问题,对SDM的看法是耗时且困难的,并且由于医疗保健的快速发展及其快速决策而受到限制。此外,感知的复杂性因情况而异,受同事态度的影响,具有有限的可试验性和稀疏观察的SDM实例。
结论:临床医生采用或拒绝SDM的决定是多方面的,由信仰塑造,认知过程和情境挑战。认知失调至关重要,因为临床医生将其现有实践与SDM的采用相协调。实践评估等实践策略,通过专业发展计划,公开讨论SDM的实用性和反思实践,使临床医生能够做出最明智的决定,采用或拒绝SDM。
OBJECTIVE: This study uses the diffusion of innovations (DOI) theory to comprehensively understand the adoption of shared decision-making (SDM) in clinical practice, specifically focusing on the \'knowledge\' and \'persuasion\' stages within DOI. We aim to understand the challenges and dynamics associated with SDM adoption, offering insights for more patient-centred decision-making in healthcare.
METHODS: This qualitative study employs a modified framework analysis approach, integrating ethnographic and interview data from prior research, along with additional interviews. The framework used is based on the DOI theory.
METHODS: This study was conducted in the obstetrics and gynaecology department of a tertiary teaching hospital in the Eastern region of the Netherlands. It included interviews with 20 participants, including gynaecologists, obstetrics registrars and junior doctors currently practising in the department. Additionally, data from prior research conducted within the same department were incorporated, ensuring the maintenance of contextual consistency.
RESULTS: Findings reveal a complex interplay between SDM\'s benefits and challenges. Clinicians value SDM for upholding patient autonomy and enhancing medical practice, viewing it as valuable for medical decision-making. Decision aids are seen as advantageous in supporting treatment decisions. Challenges include compatibility issues between patient and clinician preferences, perceptions of SDM as time-consuming and difficult and limitations imposed by the rapid pace of healthcare and its swift decisions. Additionally, perceived complexity varies by situation, influenced by colleagues\' attitudes, with limited trialability and sparsely observed instances of SDM.
CONCLUSIONS: Clinicians\' decision to adopt or reject SDM is multifaceted, shaped by beliefs, cognitive processes and contextual challenges. Cognitive dissonance is critical as clinicians reconcile their existing practices with the adoption of SDM. Practical strategies such as practice assessments, open discussions about SDM\'s utility and reflective practice through professional development initiatives empower clinicians to make the best informed decision to adopt or reject SDM.