Journal Article EBMからShared Decision Makingへ:より良質なFavorable Outcomeの追求

佐地, 勉

63 ( 1 )  , pp.16 - 19 , 2016-03 , 東邦大学医学会
臨床の場での治療方針の決定は,患者側の価値を最大限に考慮したものでなくてはならないとされ,これをShared Decision Making(SDM)と呼んでいる.すなわちevidence based medicine(EBM)だけの情報だけでは決めてはいけない時代へと変遷してきた.人生は,胎芽期,胎児期から始まり,新生児期,乳幼児期,学童期,思春期,さらに成人期,壮年期,そして老年期に至るまで,小児期における生活様式や環境が,遺伝子支配の領域を超えて,その人の長い人生に密接に関わってくることが分かってきた.日々の診療で,こどもの20年後や30年後を見据えた長期的視野に立った治療選択をして,次の世代に受け渡してゆくことが求められる.そして成人期医学のさらなる発展に見合う,その要求に十分に答えられる基礎データを次世代に継承してゆく使命が,われわれ小児科医にはあるのではないであろうか.それが,成人から老人となるまでのひとつの人生を過ごして行くうえで,世代を超えた医療に結びつく重要な“人生の診療録:Life-long medical records”となるのではないであろうか.Interest in Shared Decision-Making (SDM) in clinical settings has increased during the past few decades. Clinicians usually make decisions regarding patients after considering medical evidence and/or recommendations in guidelines, patient socioeconomic status, philosophy, and religion, and the experience of the physician and hospital. However, we must also consider the role of value-based practice in ensuring patient well-being and outcomes. Individualized decision-making requires rapport and partnership between clinicians and patients. Of course, this process must be designed to provide patient-centered care. Human life proceeds from fetus to neonate, infant, child, adolescent, and young adult and then to middle and old age. Lifestyle, environment, and health interventions during childhood can affect health status in adulthood, including insulin resistance, hypertension, obesity, and atherosclerosis. By analyzing factors such as socioeconomic status and risk-benefit perception, we need to consider the effects on quality of life more than 20 to 30 years in the future. As part of this process, medical records should be maintained for the entire life of patients, from pediatric to geriatric care.

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