@文章{信息:doi/10.2196/31699，作者="Buchanan, Francine和Lai, Claudia和Cohen, Eyal和Milo-Manson, Golda和Shachak, Aviv"，标题="有医学复杂性的儿童父母的决策:活动理论分析"，期刊="J Particip Med"，年="2022"，月="Jan"，日="17"，卷="14"，数="1"，页数="e31699"，关键词="共享决策;活动理论;父母的决策;父母;参与医学;儿科;背景:共享决策(SDM)是一种以协作方式达成决策共识的方法，被认为是医疗遭遇中理想的决策模式。SDM框架在很大程度上是根据一名有能力的成年患者面临单一医疗问题的临床背景开发的，该患者在坚实的证据基础上提出了多种治疗方案。很难将这一模型应用于儿科环境和患有医学复杂性(CMC)的儿童，特别是因为CMC的父母经常面临无数相互关联的决定，而关于多种复杂和共存的慢性疾病的证据很少。因此，基于传统SDM模型开发的解决方案可能不会改善cmc的SDM实践，并且可能是导致cmc实施SDM率低的一个因素。 Objective: The goal of our study was to address the gaps in the current approach to SDM for CMC by better understanding the decision-making activity among parents of CMCs and exploring what comprises their decision-making activity. Methods: We interviewed 12 participants using semistructured interviews based on activity theory. Participants identified as either a parent of a CMC or a CMC over the age of 18 years. Qualitative framework analysis and an activity theory framework were employed to understand the complexity of the decision-making process in context. Results: Parents of CMCs in our study made decisions based on a mental model of their child's illness, informed by the activities of problem-solving, seeking understanding, obtaining tests and treatment, and caregiving. These findings suggest that the basis for parental choice and values, which are used in the decision-making activity, was developed by including activities that build concrete understanding and capture evidence to support their decisions. Conclusions: Our interviews with parents of CMCs suggest that we can address both the aims of each individual activity and the related outcomes (both intended and unintended) by viewing the decision-making activity as a combination of caregiving, problem-solving, and seeking activities. Clinicians could consider using this lens to focus decision-making discussions on integrating the child's unique situation, the insights parents gain through their decision-making activity, and their clinical knowledge to enhance the understanding between parents and health care providers, beyond the narrow concept of parental values. ", issn="2152-7202", doi="10.2196/31699", url="https://jopm.www.mybigtv.com/2022/1/e31699", url="https://doi.org/10.2196/31699", url="http://www.ncbi.nlm.nih.gov/pubmed/35037890" }