关键词: 医患共享决策, 内隐原型, 医患权势不平衡, 医患沟通

Abstract:

Doctor-patient shared decision-making (SDM) is widely advocated as ideal for making medical decisions because it is believed to yield good results. Previous researchers have summarized the influencing factors of SDM from various perspectives; however, they have not systematically focused on the psychological mechanism of how these factors operate. Based on implicit leadership and followership prototypes, this paper introduces the perspective of implicit prototypes in doctor-patient SDM and proposes implicit SDM prototypes of doctors and patients for themselves and their counterparts. The implicit SDM prototype of doctors and patients is a set of cognitive schemas that they develop about “their own or their counterparts’ SDM behaviors,” which reflect the extent to which they expect themselves or their counterparts to exhibit SDM behaviors. Moreover, doctors and patients do not have the same implicit SDM prototypes for themselves or their counterparts and, hence, have different expectations about whether the patient or doctor needs to engage in SDM.
This paper clarifies the implicit prototype psychological pathways in which individual characteristics affect SDM (individual characteristics of doctors and patients → their potential psychological states → their implicit SDM prototypes → their SDM). Individual characteristics may influence the psychological states of doctors and patients, their implicit SDM prototypes, and their SDM.
Dividing the four implicit SDM prototype psychological paths, this paper reviews the previous studies that have focused on the effect of individual characteristics of doctors and patients on SDM. First, studies focusing on the effect of the individual characteristics of doctors and patients on SDM have found that patients’ and doctors’ characteristics influence SDM by seeking advantages and avoiding disadvantages, such as emotions, outcomes, and interpersonal feedback or experienced power states. This paper proposes that patients’ and doctors’ motivations and experienced power states may influence SDM through their implicit SDM prototypes for themselves. Second, studies focusing on the effect of individual characteristics of doctors and patients on their counterparts’ SDM have found that doctors’ medical service and interaction characteristics with patients influence patients’ SDM through the relative deprivation and psychological empowerment experienced by patients and that patients’ individual characteristics influence doctors’ SDM through their heuristic cognitive judgments of patients. This paper proposes that the relative deprivation and psychological empowerment experienced by patients may influence their SDM through their implicit SDM prototypes for doctors. Doctors’ heuristic cognitive judgments of patients may influence their SDM through their implicit SDM prototypes for patients.
Finally, according to the implicit SDM prototype research framework, several potential topics are discussed for future studies, including but not limited to exploring individual characteristics of doctors and patients that influence SDM, investigating the potential psychological states of doctors and patients influenced by their individual characteristics, testing the role of doctors’ and patients’ implicit SDM prototypes, and focusing on the moderators of the effect of individual characteristics of doctors and patients.

Key words: shared decision-making, implicit prototype, doctor-patient power imbalance, doctor-patient communication