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首页> 外文期刊>Journal of participatory medicine. >Personalizing Value in Cancer Care: The Case for Incorporating Patient Preferences Into Routine Clinical Decision Making
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Personalizing Value in Cancer Care: The Case for Incorporating Patient Preferences Into Routine Clinical Decision Making

机译：癌症护理中的个性化价值：将患者偏好纳入常规临床决策的案例

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Despite growing research demonstrating the potential for shared decision making (SDM) to improve health outcomes, patient preferences—including financial trade-offs—are still not routinely incorporated into health care decision making. As the US health care delivery system transitions to rewarding value-based care, the question of “value to whom?” assumes greater importance. To achieve the goals of value-based care, the patient voice must be incorporated into clinical decision making by embedding SDM as a routine part of clinical practice. Identified as a priority by the Centers for Medicare & Medicaid Services (CMS), SDM-related measures and initiatives have already been integrated into CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) demonstration projects (eg, the Oncology Care Model and Transforming Clinical Practice Initiative) and value-based payment programs (eg, the Merit-based Incentive Payment System, Medicare Shared Savings Program) to incentivize more proactive SDM engagement between patients and their providers. Furthermore, CMS has also integrated formal shared decision-making encounters into coverage and reimbursement policies (eg, for implantable cardioverter defibrillators), demonstrating a growing interest in SDM and its potential for eliciting and promoting the integration of patient preferences into the clinical decision-making process. In addition to increasing policy efforts to promote SDM, we need more research investments aimed at understanding how to optimize the science and practice of meaningful SDM. The current landscape and proposed road map for next steps in research, outlined in this review article, will help ensure the transition of pilots and research projects regarding the implementation of SDM into sustainable solutions.
机译：尽管越来越多的研究表明共享决策（SDM）可以改善健康状况，但患者的偏好（包括财务权衡）仍然没有常规纳入医疗保健决策中。随着美国医疗保健提供系统向奖励性基于价值的护理过渡，“对谁有价值”的问题。更重要。为了实现基于价值的护理的目标，必须通过将SDM嵌入作为临床实践的常规部分，将患者的声音纳入临床决策。由医疗保险和医疗补助服务中心（CMS）确定为优先事项，与SDM相关的措施和倡议已被纳入CMS的医疗保险和医疗补助创新中心（创新中心）示范项目（例如，肿瘤护理模型和转化）临床实践计划）和基于价值的支付计划（例如基于绩效的奖励支付系统，Medicare共享储蓄计划），以激励患者及其提供者之间更积极的SDM参与。此外，CMS还已将正式的共享决策制定经验整合到承保和报销政策中（例如，对于植入式心脏复律除颤器），这表明对SDM的兴趣日益增长，其在SDM方面的潜力越来越大，可以激发并促进将患者的偏好整合到临床决策中处理。除了加大政策力度来促进SDM之外，我们还需要更多的研究投资，旨在了解如何优化有意义的SDM的科学和实践。这篇评论文章中概述了当前的现状和下一步研究的拟议路线图，将有助于确保将实施SDM的试点和研究项目过渡到可持续解决方案。

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