Capítulo 4. Un sistema de salud integrado y centrado en los usuarios
¿Cómo incorporar las utilidades de los pacientes a las decisiones clínicas? Informe SESPAS 2008
How should patients’ utilities be incorporated into clinical decisions?
José María Abellán Perpiñán
, Fernando I. Sánchez Martínez, Jorge E. Martínez Pérez
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Universidad de Murcia, Murcia, España
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"apellidos" => "Jesús Quintana" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911108760898?idApp=WGSE" "url" => "/02139111/00000022000000S1/v1_201301221349/S0213911108760898/v1_201301221349/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Capítulo 4. Un sistema de salud integrado y centrado en los usuarios</span>" "titulo" => "¿Cómo incorporar las utilidades de los pacientes a las decisiones clínicas? Informe SESPAS 2008" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "179" "paginaFinal" => "185" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José María Abellán Perpiñán, Fernando I. Sánchez Martínez, Jorge E. Martínez Pérez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "José María" "apellidos" => "Abellán Perpiñán" "email" => array:1 [ 0 => "dionisos@um.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "Fernando I." "apellidos" => "Sánchez Martínez" ] 2 => array:2 [ "nombre" => "Jorge E." "apellidos" => "Martínez Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Universidad de Murcia, Murcia, España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: José María Abellán Perpiñán. Universidad de Murcia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "How should patients’ utilities be incorporated into clinical decisions?" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13668" "palabras" => array:5 [ 0 => "Toma de decisiones compartidas" 1 => "Análisis de la decisión" 2 => "Utilidades de los pacientes" 3 => "Ayudas a la decisión" 4 => "Guías de práctica clínica" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13667" "palabras" => array:5 [ 0 => "Shared decision-making" 1 => "Decision analysis" 2 => "Patients’ utilities" 3 => "Decision aids" 4 => "Clinical practice guidelines" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Hay muchas situaciones clínicas en las que no se puede tomar una decisión «correcta» desde el punto de vista técnico. Ejemplo de ello sería la cirugía electiva, donde atender las preferencias de los pacientes resulta ineludible. Una forma de incorporar dichas preferencias es la aplicación del análisis de las decisiones clínicas. En este enfoque, primero se cuantifican dichas preferencias (utilidades) y después se combinan con los conocimientos técnicos del médico. Al modelo resultante de toma de decisiones se le suele denominar «toma de decisiones compartidas». En la revisión efectuada en este artículo se constata que: <span class="elsevierStyleItalic">a)</span> dicho modelo, en caso de aplicarse sistemáticamente, podría mejorar la efectividad de los tratamientos y el bienestar de los pacientes; <span class="elsevierStyleItalic">b)</span> la práctica clínica, no obstante, se enfrenta a restricciones en forma de tiempo y recursos disponibles que hacen difícil su aplicación; <span class="elsevierStyleItalic">c)</span> la incorporación de las utilidades de los pacientes a las guías de práctica clínica podría contribuir a estrechar la distancia que separa las preferencias de los médicos de las de los pacientes; <span class="elsevierStyleItalic">d)</span> aparentemente, la aplicación de este tipo de análisis en España es muy ocasional, donde, incluso, se detectan deficiencias, no ya en la participación de los pacientes en las decisiones clínicas, sino en el ejercicio del derecho a la información, y <span class="elsevierStyleItalic">e)</span> la alternativa de las ayudas a la decisión, aun cuando conozca una creciente expansión, no está libre de problemas.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">There are many clinical situations in which there is no “right” decision from a technical point of view. An example of this is elective surgery, in which patients’ preferences are critical. One way to integrate patients’ preferences within clinical practice is the application of decision analysis.</p><p class="elsevierStyleSimplePara elsevierViewall">According to this approach, preferences (utilities) are assessed and are then combined with physicians’ knowledge. This combination of evidence and utilities leads to the so-called shared decision-making (SDM) model.</p><p class="elsevierStyleSimplePara elsevierViewall">The overview provided in the present article indicates that: <span class="elsevierStyleItalic">a)</span> The SDM model, if systematically applied, could improve treatment effectiveness and patients well being; <span class="elsevierStyleItalic">b)</span> clinical practice, nevertheless, faces barriers in the form of time and resource constraints, limiting the application of such a model; <span class="elsevierStyleItalic">c)</span> discrepancies between patients’ and doctors’ preferences could be narrowed if patients’ utilities were included in clinical practice guidelines; <span class="elsevierStyleItalic">d)</span> the application of this kind of analysis seems to be scarce in Spain. Moreover, information provided to patients is probably insufficient; and <span class="elsevierStyleItalic">e)</span> patient decision aids, even though their use is rapidly growing, are subject to certain problems.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Four models of the physician-patient relationship" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.J. Emanuel" 1 => "L.L. Emanuel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Med Assoc" "fecha" => "1992" "volumen" => "267" "paginaInicial" => "2221" "paginaFinal" => "2226" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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