切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (11) : 1142 -1145. doi: 10.3877/cma.j.issn.1674-0785.2022.11.019

医学人文

医疗决策中的循证与叙事依据
严楠1, 杜丽雪1, 依斯坎德尔·依沙江1, 宋美娜1, 王非1, 王仲1,()   
  1. 1. 102218 北京,清华大学附属北京清华长庚医院 清华大学临床医学院
  • 收稿日期:2022-04-10 出版日期:2022-11-15
  • 通信作者: 王仲

Evidence-based medicine and narrative evidence in medical decision making

Nan Yan1, Lixue Du1, Yishajiang Yisikandeer1, Meina Song1, Fei Wang1, Zhong Wang1,()   

  1. 1. Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2022-04-10 Published:2022-11-15
  • Corresponding author: Zhong Wang
引用本文:

严楠, 杜丽雪, 依斯坎德尔·依沙江, 宋美娜, 王非, 王仲. 医疗决策中的循证与叙事依据[J/OL]. 中华临床医师杂志(电子版), 2022, 16(11): 1142-1145.

Nan Yan, Lixue Du, Yishajiang Yisikandeer, Meina Song, Fei Wang, Zhong Wang. Evidence-based medicine and narrative evidence in medical decision making[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(11): 1142-1145.

医疗决策是临床工作的重要一环。医疗决策有赖于对患者状态的评价,也有赖于对患者(和家属)心理、躯体感受的评价。本文通过一例恶性肿瘤晚期患者的常规诊疗和安宁疗护过程中的医疗决策过程,分析主观证据和客观证据在决策中的应用,进而分析循证医学和叙事医学在医疗决策中的地位。

Medical decision-making is an important part of clinical work. Medical decisions depend on the evaluation of the patient's state, as well as on the evaluation of the patient's (and family's) psychological and somatic feelings. In this paper, we analyze the application of subjective evidence and objective evidence in decision-making through the medical decision-making process of routine diagnosis/treatment and hospice care of a patient with advanced malignancy, and discuss the status of evidence-based medicine and narrative medicine in medical decision-making.

表1 患者终末期医疗决策中的循证与叙事医学
1
Kie JH, Lee MK, Kim CJ, et al. Primary Ewing's sarcoma of the suodenum: a case report [J]. Int J Surg Pathol, 2003, 11(4):331-337.
2
Nissim L, Mandell G. Gastric Ewing Sarcoma identified on a Meckel's scan [J]. Radiol Case Rep, 2020, 15(8):1235-1237.
3
Javery O, Krajewski K, O'Regan K, et al. A to Z of extraskeletal Ewing sarcoma family of tumors in adults: imaging features of primary disease, metastatic patterns, and treatment responses [J]. AJR Am J Roentgenol, 2011, 197(6):W1015-W1022.
4
Kopel JJ, White WL. Evidence and narrative based medicine: a synthesis for addiction medicine? [J]. Alcohol Treat Q, 2020, 38(3): 395-397.
5
Schenker Y, Crowley-Matoka M, Dohan D, et al. I don't want to be the one saying 'we should just let him die': intrapersonal tensions experienced by surrogate decision makers in the ICU [J]. J Gen Intern Med, 2012, 27(12):1657-1665.
6
Moss KO, Douglas SL, Baum E, et al. Family surrogate decision-making in chronic critical illness: a qualitative analysis [J]. Crit Care Nurse, 2019, 39(3):e18-18e26.
7
Jeon BM, Kim SH, Lee SJ. Decisional conflict in end-of-life cancer treatment among family surrogates: A cross-sectional survey [J]. Nurs Health Sci, 2018, 20(4):472-478.
8
Haidet P, Kroll TL, Sharf BF. The complexity of patient participation: lessons learned from patients' illness narratives [J]. Patient Educ Couns, 2006, 62(3):323-329.
9
Carmona C, Crutwell J, Burnham M, et al. Shared decision-making: summary of NICE guidance [J]. BMJ, 2021, 373:n1430.
10
Greenhalgh T, Hurwitz B. Narrative based medicine: why study narrative? [J]. BMJ, 1999, 318(7175):48-50.
11
Charon R, Wyer P, NEBM Working Group. Narrative evidence based medicine [J]. Lancet, 2008, 371(9609):296-297.
[1] 龙天柱, 姚育芝, 罗家月, 蔡媛璇, 梁震, 樊哲, 朱彩荣, 潘玉鸿, 马宏民. 哺乳期乳腺脓肿抗生素治疗的回顾性研究[J/OL]. 中华乳腺病杂志(电子版), 2021, 15(04): 214-217.
[2] 中华医学会骨科学分会关节外科学组, 解放军总医院第四医学中心骨科医学部, 国家骨科与运动康复临床医学研究中心. 中国膝骨关节炎非手术治疗专家共识(2023年版)[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 151-159.
[3] 洪东琪, 叶臻. 真实世界研究在骨关节炎领域的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 137-141.
[4] 中华医学会骨科学分会关节外科学组, 云南省创伤骨科临床医学中心(解放军联勤保障部队第九二〇医院). 中国髋关节置换入路选择临床实践指南(2021年版)[J/OL]. 中华关节外科杂志(电子版), 2021, 15(06): 651-659.
[5] 钱警语, 郑明明. 《2024意大利妇产科学会非侵入性和侵入性产前诊断指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 486-492.
[6] 贾俊君, 殳儆, 唐秋梅, 丁维燕, 郑树森. 叙事医学在器官移植中的应用及价值[J/OL]. 中华移植杂志(电子版), 2023, 17(06): 381-384.
[7] 刘骞. 直肠癌侧方淋巴结清扫中国临床开展的现状[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(05): 367-371.
[8] 王锡山. 随机对照临床试验在外科中的局限性[J/OL]. 中华结直肠疾病电子杂志, 2021, 10(05): 457-461.
[9] 陈意志. 老年人肾小球滤过率估算公式的选择及预后意义:基于循证医学的证据解读[J/OL]. 中华肾病研究电子杂志, 2023, 12(06): 360-360.
[10] 郑颖, 孟金铃, 蔡广研, 冯哲. 混合式教学模式在肾脏病学专业学位研究生循证医学课程中的实践与思考[J/OL]. 中华肾病研究电子杂志, 2023, 12(01): 48-50.
[11] 吴宗盛, 谢剑锋, 邱海波. 2021版拯救脓毒症运动指南:早期复苏的八大“陷阱”[J/OL]. 中华重症医学电子杂志, 2023, 09(01): 14-18.
[12] 陈明敏, 任菁菁. 全科医师叙事能力探讨与思考[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 836-840.
[13] 邱凯锋, 王则远, 何志超, 付凯利, 梅童霖, 关英杰, 高飞, 伍俊妍. 人工智能技术在超说明书用药循证中的应用研究[J/OL]. 中华临床医师杂志(电子版), 2023, 17(12): 1212-1218.
[14] 赵楠琦, 武晓冬, 牟东晓, 丁楠, 胡静. 基于针灸临床实践指南制定的古代医家经验作用价值分析[J/OL]. 中华针灸电子杂志, 2024, 13(04): 140-144.
[15] 王晓玲, 杨婷, 尹专叶, 张颖. 脑卒中后抑郁状态识别与预防的最佳证据总结[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(01): 51-56.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?