8病人价值观08-12

PatientValuesandPatientSafety/Cochrane200812(Contents)(Contents)••(Background)(Background)••(Patientvalues)(Patientvalues)••(Howtoelicit)(Howtoelicit)••Patientsafety)Patientsafety)••Futurepatient)Futurepatient)QuestionQuestion••Whysoimportant?Whysoimportant?Smoking:aleadingcauseofSmoking:aleadingcauseofpreventablediseasepreventablediseaseObesity:becomingaglobalObesity:becomingaglobalepidemicepidemic**WhatChallenges?WhatChallenges?QuestionQuestionChallengesfacingdoctor?Challengesfacingdoctor?Findout:Findout:WhatunhealthybehaviorstheirWhatunhealthybehaviorstheirpatientshave?patientshave?Howtheycanbepersuadedtochange?Howtheycanbepersuadedtochange?Weshouldlearn:Weshouldlearn:MindMind--bodyinteractionsbodyinteractionsfocusonfocusonbiological,biological,behavioral,behavioral,psychologicalpsychologicalsocialfactorsthatcansocialfactorsthatcancompromisehealthcompromisehealthPatientbehaviorPatientbehaviorHelpthemdevelopinterventionsHelpthemdevelopinterventionsandpromotebehaviorchangeandpromotebehaviorchangePhysicianroleandbehaviorPhysicianroleandbehaviorPhysicianPhysician’’spersonalbackground,spersonalbackground,beliefsandbiasesaffectpatientbeliefsandbiasesaffectpatientcarecare••PhysicianPhysician--patientpatientinteractionsinteractionsEffectivecommunicationEffectivecommunicationBasedon:Basedon:DifferentsocialculturalandDifferentsocialculturalandeconomicbackgroundseconomicbackgrounds••SocialandculturalissuesSocialandculturalissuesinhealthcareinhealthcareProvidingappropriatecareProvidingappropriatecaretopatientswithdifferenttopatientswithdifferentsocial,cultural,andsocial,cultural,andeconomicbackgroundeconomicbackgroundWhatdowelearn?Whatdowelearn?••HealthcareserviceorHealthcareserviceorpracticeisnotjustaprocesspracticeisnotjustaprocessoftreatingdiseaseoftreatingdiseasebutbutsomethingmoreorbeyond!!somethingmoreorbeyond!!MoreMore…………Background••AdvancesabroadAdvancesabroad--PatientcenteredapproachorconceptPatientcenteredapproachorconcept--PatientorconsumerorganizationsPatientorconsumerorganizations--HealthinformationaccessHealthinformationaccess--EvidenceEvidence--basedmedicinebasedmedicineIBackground““””PatientPatient--centeredapproachorconceptcenteredapproachorconceptBackground••BalintBalint20205050••Byrne20Byrne207070““””••McMcWhinneyWhinney20208080::Background••Steward90Steward90::““””66Background••2121MeadMead““””““””IIBackgroundPatientorconsumerorganizationsPatientorconsumerorganizationsandinstitutionsandinstitutionsBackground1.CochraneConsumerNetwork1.CochraneConsumerNetwork2.WHOPatientforPatientSafety2.WHOPatientforPatientSafety3.3.TheInternationalAllianceTheInternationalAllianceofPatients'OrganizationsofPatients'Organizations(IAPO)(IAPO)CochraneCochraneCCNetCCNet))://!(publishedinNewspaperHealthInformation)(PICO)population:who,age,sex,sizeetc.intervention:dosage,duration,amount,etc.comparison:chocolateversenoneor…outcome:coughstopped/induced/reduced?weightgain/headache••CochraneCochrane(CochraneSummary)(CochraneSummary)WHOPatientforPatientSafetyWHOPatientforPatientSafety(((http//(http//))PatientsforPatientSafety:TheChampionsIIIIIIBackgroundInternetandothermediamakehealthinformationaccessibletopatientsandpublicDatabasesforpatientsDatabasesforpatients•DatabaseofIndividualPatientExperiences,DIPEx(dipex.org)•HealthActionInternational,HAI(haiweb.org)•ConsumersHealthForum(iapo-pts.org.uk)•DISCERN(discern.org.uk)•AgeCare(ace.org.uk)IVIVBackgroundBackgroundEvidence-BasedMedicineEvidence-BasedHealthcareDavidSackket,1994DavidSackket,1994::••,,??••??((GordenGordenGuyatt,2004)Guyatt,2004)••2121MuirGrayMuirGray20202121V------------PatientValuesandPreferencesPatientValuesandPreferencesPatientChoiceandInvolvementPatientChoiceandInvolvementModelofevidencebasedclinicaldecisionsclinicalcircumstancespatientpreferenceresearchevidenceClinicalexpertiseQuestions?••••••••••II111%1%1122RoleofpatientvalueRoleofpatientvalueComparisonofpatientandphysicianvalues•toanticoagulateornottoanticoagulatepatientswithatrialfibrillation:differencesbetweenphysicianandpatientperspectives–DevereauxPJet.al.,BMJ,2001•facetofaceinterviewof63physiciansand61patients•probabilitytrade-offtooltodetermineandcomparephysicianandpatientthresholdsforhowmuchstrokereductionisnecessaryandhowmuchbleedingriskisacceptableforantithrombotictherapyinatrialfibrillationTheChoice•withouttreatment100patientswillsuffer:–12strokes(sixmajor,sixminor),3seriousgibleedsin2years•warfarinwoulddecreasestrokesin100patientsto4per2years(8fewerstrokes,4major,minor)•howmanybleedswouldyouacceptin100patientsoverayear,andstillbewillingtoadminister/takewarfarin?PatientValuesinClinicalDecision-making•EBMandtheroleofpatientvalues•physicianvaluesandlifeordeathdecisions•patientvaluesandphysicianvalues•howmightweelicitpatientvalues?TailoringmanagementtotheTailoring