Abstract
Canada's approach to shared decision making (SDM) remains as disparate as its healthcare
system; a conglomerate of 14 public plans – ten provincial, three territorial and
one federal. The healthcare research funding environment has been largely positive
for SDM because there was funding for knowledge translation research which also encompassed
SDM. The funding climate currently places new emphasis on patient involvement in research
and on patient empowerment in healthcare. SDM fields have expanded from primary care
to elder care, paediatrics, emergency and critical care medicine, cardiology, nutrition,
occupational therapy and workplace rehabilitation. Also, SDM has reached out to embrace
other health-related decisions including about home care and social care and has been
adapted to Aboriginal decision making needs. Canadian researchers have developed new
interprofessional SDM models that are being used worldwide. Professional interest
in SDM in Canada is not yet widespread, but there are provincial initiatives in Alberta,
British Columbia, Ontario, Quebec and Saskatchewan. Decision aids are routinely used
in some areas, for example for prostate cancer in Saskatchewan, and many others are
available for online consultation. The Patient Decision Aids Research Group in Ottawa,
Ontario maintains an international inventory of decision aids appraised with the International
Patient Decision Aid Standards. The Canada Research Chair in SDM and Knowledge Translation
in Quebec City maintains a website of SDM training programs available worldwide. These
initiatives are positive, but the future of SDM in Canada depends on whether health
policies, health professionals and the public culture fully embrace it.
Zusammenfassung
Kanadas Herangehensweise an die partizipative Entscheidungsfindung (PEF) ist nach
wie vor so uneinheitlich, wie sein Gesundheitssystem aufgebaut ist, nämlich als ein
Konglomerat aus 14 Teilsystemen: zehn provinzial- und drei territorialstaatliche sowie
ein bundesstaatliches. Die Forschungsförderung im Bereich der Gesundheitsforschung
ist gegenüber PEF im Großen und Ganzen positiv eingestellt; so wurden Projekte in
der Wissenstransferforschung finanziert, worunter auch das Thema PEF fällt. Die Förderschwerpunkte
liegen neuerdings auf der Einbeziehung von Patienten in die Forschung und auf dem
Patienten-Empowerment im Gesundheitswesen. Der Anwendungsbereich von PEF hat sich
ausgehend von der Grundversorgung inzwischen auf Altenbetreuung, Pädiatrie, Notfall-
und Intensivmedizin, Kardiologie, Ernährung, Ergotherapie sowie Arbeitsrehabilitation
ausgeweitet. Darüber hinaus erstreckt sich PEF mittlerweile auch auf andere gesundheitsbezogene
Entscheidungsprozesse, z. B. in Bezug auf häusliche Pflege und Sozialdienste, und
ist an die Entscheidungsbedürfnisse der indigenen Bevölkerungsgruppen angepasst worden.
Kanadische Wissenschaftler haben neue berufsübergreifende PEF-Modelle entwickelt,
die weltweit Anwendung finden. In Kanada ist das Interesse der einschlägigen Berufsgruppen
an PEF zwar noch nicht besonders weit verbreitet, doch gibt es in den Provinzen Alberta,
British Columbia, Ontario, Quebec und Saskatchewan verschiedene PEF-Initiativen. In
einigen Bereichen kommen routinemäßig Entscheidungshilfen für Patienten zum Einsatz,
in Saskatchewan beispielsweise bei Prostatakrebs, und viele weitere solcher Entscheidungshilfen
stehen im Rahmen von Online-Konsultationen zur Verfügung. Die Patient Decision Aids Research Group in Ottawa (Ontario) pflegt ein internationales Register von Entscheidungshilfen,
die nach den Kriterien der International Patient Decision Aids Standards (IPDAS) Collaboration
bewertet wurden. Der kanadische Forschungslehrstuhl für PEF und Wissenstransfer in
Quebec City unterhält eine Webseite zu international verfügbaren PEF-Schulungsprogrammen.
Diese Initiativen sind positiv zu bewerten, doch wird die Zukunft von PEF in Kanada
davon abhängen, ob sich Gesundheitspolitiker, Ärzte und die Öffentlichkeit uneingeschränkt
zu PEF bekennen.
Keywords
Schlüsselwörter
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Article info
Publication history
Published online: May 19, 2017
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© 2017 Published by Elsevier Inc.
