%0期刊文章%@ 2152-7202 %I JMIR出版物%V 14%卡塔尔世界杯8强波胆分析 N 1% P e31699% T有复杂医疗问题的儿童父母的决策:活动理论分析%A Buchanan,Francine %A Lai,Claudia %A Cohen,Eyal %A Milo-Manson,Golda %A Shachak,Aviv %+多伦多大学卫生政策、管理和评估研究所，学院街155号，4楼，多伦多，ON, M5T 3M6，加拿大，1 (416)978 4326，buchanan.fr@gmail.com %K共享决策%K活动理论%K家长决策%K育儿%K参与医学%K儿科%K护理%D 2022 %7 17.1.2022 %9原始论文%J J参与医学%G英文%X背景:共享决策(SDM)是一种达成决策一致的协作方法，被倡导为医疗遭遇中的理想决策模式。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。目的:我们的研究目标是通过更好地理解CMC父母的决策活动，并探索其决策活动的组成部分，来解决当前用于CMC SDM方法的差距。方法:采用基于活动理论的半结构化访谈法对12名参与者进行访谈。参与者为CMC的父母或年龄在18岁以上的CMC。采用定性框架分析和活动理论框架来理解情境下决策过程的复杂性。 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. %M 35037890 %R 10.2196/31699 %U https://jopm.www.mybigtv.com/2022/1/e31699 %U https://doi.org/10.2196/31699 %U http://www.ncbi.nlm.nih.gov/pubmed/35037890