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首页> 外文期刊>Sociology of health & illness >Advice, authority and autonomy in shared decision-making in antenatal screening: the importance of context
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Advice, authority and autonomy in shared decision-making in antenatal screening: the importance of context

机译：产前筛查共同决策中的建议，权威和自主权：背景的重要性

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Shared decision-making (SDM) has been widely advocated across many branches of healthcare, yet there is considerable debate over both its practical application and how it should be examined or assessed. More recent discussions of SDM have highlighted the important of context, both internal and external to the consultation, with a recognition that decisions cannot be understood in isolation. This paper uses conversation analysis (CA) to examine how decision-making is enacted in the context of antenatal screening consultations in Hong Kong. Building on previous CA work (Collins et al. 2005, Toerien et al. 2013), we show that, whilst previously identified formats are used here to present the need for a decision, the overriding basis professionals suggest for actually making a decision in this context is the level of worry or concern a pregnant woman holds about potential foetal abnormality. Professionals take an unknowing 'epistemic stance' (Heritage 2012) towards this worry, and hence step back from involvement in decision-making. We argue that this is linked to the non-directive ethos that prevails in antenatal screening services, and suggest that more research is needed to understand how the enactment of SDM is affected by wider professional contexts and parameters.
机译：在医疗保健的许多分支机构中广泛倡导共享决策（SDM），但是在其实际应用以及应如何检查或评估方面都存在大量争论。关于SDM的最新讨论强调了咨询内部和外部环境的重要性，并认识到不能孤立地理解决策。本文使用对话分析（CA）来研究在香港进行产前筛查咨询时如何制定决策。基于先前的CA工作（Collins等，2005; Toerien等，2013），我们表明，尽管此处使用先前确定的格式来表示决策的必要性，但基础的专业人士建议在此基础上进行实际决策背景是孕妇对潜在胎儿异常的担心或关注的程度。专业人士对这种担忧采取了不知情的“流行病立场”（Heritage 2012），因此从参与决策中退了一步。我们认为这与产前筛查服务中普遍存在的非指导性精神有关，并建议需要更多的研究来了解SDM的制定如何受到更广泛的专业背景和参数的影响。

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