Evidence-based medicine and narrative evidence in medical decision making

doi:10.3877/cma.j.issn.1674-0785.2022.11.019

Abstract

Abstract:

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.

Key words: Medical decision-making, Narrative medicine, Evidence based medicine

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

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2022.11.019

https://zhlcyszz.cma-cmc.com.cn/EN/Y2022/V16/I11/1142

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References 11

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临床问题	新发脑转移	严重血小板减低、凝血功能障碍	脑疝、休克、酸中毒
循证依据	临床表现、头颅增强CT、MDT讨论	出血倾向、血常规、凝血功能检查	Glasgow评分4分、生命体征检查、血气分析
循证治疗	降颅压、拟鞘注化疗	输注血制品、促血小板生成药物	补液支持、以血管活性药物维持生命体征
叙事问题	医疗决策陷入困境	患方情绪及心理负担大
叙事表现	决策者不明；做决策道德负担重、心理压力大	患者存在绝望、悲伤、恐惧、遗憾等多重情绪；家属存在悲伤、恐惧、期待、失望等复杂情绪
叙事治疗	组织多成员家庭会议做出医疗决策；明确决策价值观即注重生命质；给予共情与支持	了解患者期待，帮助患者完成心愿、弥补遗憾（见子女）；倾听家属叙说，帮助外化悲伤，找到对抗丧亲的力量

临床问题	新发脑转移	严重血小板减低、凝血功能障碍	脑疝、休克、酸中毒
循证依据	临床表现、头颅增强CT、MDT讨论	出血倾向、血常规、凝血功能检查	Glasgow评分4分、生命体征检查、血气分析
循证治疗	降颅压、拟鞘注化疗	输注血制品、促血小板生成药物	补液支持、以血管活性药物维持生命体征
叙事问题	医疗决策陷入困境	患方情绪及心理负担大
叙事表现	决策者不明；做决策道德负担重、心理压力大	患者存在绝望、悲伤、恐惧、遗憾等多重情绪；家属存在悲伤、恐惧、期待、失望等复杂情绪
叙事治疗	组织多成员家庭会议做出医疗决策；明确决策价值观即注重生命质；给予共情与支持	了解患者期待，帮助患者完成心愿、弥补遗憾（见子女）；倾听家属叙说，帮助外化悲伤，找到对抗丧亲的力量

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