全科医学视角下多病共存患者的医患共同决策

冯灿灿; 史威力; 刘志辉; 王留义

doi:10.16766/j.cnki.issn.1674-4152.004319

全科医学视角下多病共存患者的医患共同决策

doi: 10.16766/j.cnki.issn.1674-4152.004319

河南省人民医院/郑州大学人民医院全科医学科，河南郑州 450003

基金项目:

河南省医学科技攻关计划项目 RKX202401003

详细信息

通讯作者:
王留义，E-mail：wly2000@126.com

中图分类号: R499 R592
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- 文章访问数: 20
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- PDF下载量: 19
- 被引次数: 0
出版历程
- 收稿日期: 2025-05-27
- 网络出版日期: 2026-04-01

Shared decision-making in patients with multimorbidity from the perspective of general practice

Department of General Practice, Henan Provincial People ' s Hospital/People ' s Hospital of Zhengzhou University, Zhengzhou, Henan 450003, China

摘要

摘要: 随着预期寿命的持续增加以及生活方式风险因素的改变，多病共存已成为全球性公共卫生问题，与过早死亡、功能残疾、住院时间延长及医疗费用激增等一系列不良健康结局密切相关。此类患者疾病复杂、个体差异显著，传统的以单病种为核心的专科医疗模式在应对时常面临诊疗碎片化、治疗方案冲突、过度医疗与管理缺乏连续性等诸多局限。因此，对多病共存患者的管理，迫切需要超越单一疾病的思维，统筹兼顾个体疾病治疗与整体健康维护，并审慎平衡有限医疗资源与患者多元化的个体需求。医患共同决策作为以患者为中心的核心实践，通过整合医学证据与患者偏好制定个性化方案，在提升沟通质量、治疗依从性及患者满意度方面优势显著。全科医学凭借连续性、整体性照护特点，以“全人健康”理念为基础，通过多学科协作、长期医患信任关系构建等策略，为多病共存患者的共同决策提供了理想框架。全科医生作为协调者、信息提供者与支持者，能有效应对决策中的信息不对称、患者参与意愿差异等问题。本文系统梳理多病共存患者实施医患共同决策的挑战，包括时间限制、权力失衡、社会环境影响等，总结全科医学在整合诊疗路径、应用决策辅助工具等方面的策略，并提出未来需探索不同医疗场景的实践模式及开发专属工具，旨在为构建更具效率、更具人性化的多病共存管理体系提供理论依据与实践参考。
- 多病共存 /
- 医患共同决策 /
- 全科医学 /
- 综合管理 /
- 慢性病 /
- 患者参与 /
- 决策支持工具
Abstract: With the continuous increase in life expectancy and changes in lifestyle-related risk factors, multimorbidity has become a global public health challenge and is closely associated with a series of adverse health outcomes, including premature death, functional disability, prolonged hospitalization, and escalating healthcare costs. Patients with multimorbidity often present with complex clinical conditions and significant individual differences. The traditional specialty-oriented, single-disease-centered medical models frequently face limitations like fragmented diagnosis and treatment, conflicting treatment recommendations, overmedicalization, and lack of continuity in care. Thus, effective management of patients with multimorbidity requires moving beyond a single-disease view, integrating individual disease treatment with overall health maintenance, and carefully balancing limited medical resources against the diverse individual needs of patients. Shared decision-making (SDM), as a core patient-centered practice, facilitates the development of personalized care plans by integrating medical evidence with patient ' s preferences, demonstrating significant advantages in improving communication quality, treatment adherence, and patient satisfaction. General practice, characterized by continuity and holistic care and is based on the concept of "whole-person health", provides an ideal framework for SDM in patients with multimorbidity through strategies such as multidisciplinary collaboration and the establishment of long-term. General practitioners, acting as coordinators, information providers, and supporters, can effectively address issues such as information asymmetry and varying degrees of patient engagement during decision-making process. This article systematically reviews the challenges with implementing SDM in patients with multimorbidity, including time constraints, power imbalances, and the influence of social environment. It also summarizes strategies in general practice-based strategies for integrating care pathways and applying decision support tools, and proposes the need for future exploration of practical SDM models and the development of context-specific tools for different medical scenarios in the future. The aim is to offer theoretical foundations and practical guidance for constructing a more efficient and patient-centered multimorbidity management system.
- Multiple diseases /
- Shared decision-making /
- General practice /
- Comprehensive management /
- Chronic diseases /
- Patient participation /
- Decision-support tools

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参考文献(27)

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