TY -的AU -布坎南,弗朗辛AU -赖,克劳迪娅AU -科恩,Eyal盟——Milo-Manson,非盟- Shachak夫人特拉维夫PY - 2022 DA - 2022/1/17 TI -决策与医学的复杂性:儿童的父母活动理论分析乔- J Particip SP - e31699六世- 14 - 1 KW -共享决策KW -活动理论KW -父母决策KW -育儿千瓦参与式医学KW -儿科KW -护理AB -背景:共享决策(SDM)是一种达成决策共识的协作方法，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。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。结果:在我们的研究中，cmc的父母根据他们孩子疾病的心理模型做出决定，并通过解决问题、寻求理解、获得测试和治疗以及护理的活动得到信息。 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. SN - 2152-7202 UR - https://jopm.www.mybigtv.com/2022/1/e31699 UR - https://doi.org/10.2196/31699 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037890 DO - 10.2196/31699 ID - info:doi/10.2196/31699 ER -