Abstract
Patients’ rights to autonomy, information and participation in their own health care
are recognized in the Spanish legal system from the early 2000's. Public institutions
have progressively launched several initiatives to promote and improve patients’ empowerment
and self-care. However, the concept of shared decision making (SDM), although embedded
in the more general concept of “active/empowered patient”, usually has not been specifically
advocated as an essential requisite for improving the quality of health services,
either in the legal normative or the existing educational proposals. Research on SDM
and the development of Patient Decision Aids (PtDAs) has increasingly grown and currently
there are several of these materials available for patients with different diseases.
Along with this research activity, the growing interest of patients and professionals
in patient participation and SDM makes us optimistic about a gradual development of
this care model in the medium term. However, there are several limitations and challenges
that must be overcome in the near future. The implementation of PtDAs in clinical
practice is imperative and issues such as their inclusion in clinical guidelines and
electronic medical records should be encouraged. Concurrently, it is necessary to
train professionals in SDM skills and the use of encounter PtDAs.
Zusammenfassung
Das Recht des Patienten auf Autonomie, auf Informationen in Bezug auf die eigene Gesundheitsversorgung
und seine Teilhabe daran wird vom spanischen Rechtssystem seit Anfang der 2000er-Jahre
anerkannt. Nach und nach haben öffentliche Institutionen mehrere Initiativen auf den
Weg gebracht, welche die Stellung des Patienten durch Information, Mitentscheidung
und Teilhabe (Empowerment) sowie seine Selbstfürsorge fördern und verbessern sollen.
Das Konzept der partizipativen Entscheidungsfindung (PEF) ist zwar in das allgemeinere
Konzept des ,,aktiven/befähigten Patienten“ eingebettet, wird in der Regel aber weder
im Rahmen der gesetzlichen Vorgaben noch der bestehenden Bildungsangebote als wesentliche
Voraussetzung für die Verbesserung der Qualität von Gesundheitsleistungen speziell
gefördert. Die Forschung über partizipative Entscheidungsfindung und die Entwicklung
von Entscheidungshilfen für Patienten gewinnen zunehmend an Bedeutung, und gegenwärtig
sind mehrere solcher Materialien für Patienten mit den verschiedensten Krankheitsbildern
verfügbar. Neben diesen Forschungsaktivitäten stimmt uns auch das wachsende Interesse
von Patienten und Ärzten an partizipativer Entscheidungsfindung und an der Einbindung
von Patienten in ihre Versorgung zuversichtlich, was auf mittlere Sicht die schrittweise
Weiterentwicklung dieses Versorgungsmodells betrifft. Es bestehen allerdings gewisse
Einschränkungen und Herausforderungen, die in naher Zukunft bewältigt werden müssen.
Die Implementierung von Entscheidungshilfen für Patienten in die klinische Praxis
ist unerlässlich und Aspekte wie die Berücksichtigung von Entscheidungshilfen in klinischen
Leitlinien und elektronischen Krankenakten sollten gefördert werden. Gleichzeitig
ist es notwendig, medizinische Fachkräfte in PEF-Fertigkeiten und im Einsatz von Entscheidungshilfen
für Patienten zu schulen.
Keywords
Schlüsselwörter
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Article info
Publication history
Published online: May 18, 2017
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© 2017 Published by Elsevier Inc.
