晚期肿瘤姑息放疗护理中共享决策的 伦理意蕴与实践路径

Ethical Implications and Practice Pathways of Shared Decision-Making in Palliative Radiotherapy Nursing for Advanced Cancer

摘要: 目的：探讨共享决策在晚期肿瘤姑息放疗护理中的伦理基础、实践困境与推进策略，为构建本土化终末期护理决策模式提供参考。方法：基于伦理学理论与我国姑息放疗临床情境，通过文献分析与理论思辨，系统梳理共享决策的核心要素、伦理意蕴及实践路径。结果：共享决策在姑息放疗护理中呈现为信息传递、价值澄清至协商共识的渐进过程，护理人员承担信息中介与价值协调者角色；其伦理基础涵盖从程序性知情向实质性赋权的转变、获益与负担权衡中的伦理相称性，以及关怀伦理视域下对患者情感需求的回应。当前实践面临家庭决策主导与患者自主权的文化张力、治疗预期错位与信息传递的伦理两难、结构性沟通约束及本土化决策辅助工具匮乏等多重困境。结论：建议构建基于价值观评估的决策前置机制，开发图形化与标准化决策辅助工具，推行护士主导的多学科协作模式，并建立贯穿治疗全程的持续性评估与动态反馈框架，以推动共享决策的本土化落地，实现患者决策尊严与生命质量的协同保障。

Abstract: Objective: To explore the ethical foundation, practical dilemmas, and promotion strategies of shared decision-making (SDM) in palliative radiotherapy nursing for advanced cancer, providing a reference for constructing a localized end-of-life nursing decision-making model. Methods: Based on ethical theories and the clinical context of palliative radiotherapy in China, the core elements, ethical implications, and practice pathways of shared decision-making were systematically elaborated through literature analysis and theoretical reflection. Results: Shared decision-making in palliative radiotherapy nursing manifests as a progressive process from information transfer and value clarification to negotiated consensus, with nursing professionals serving as information intermediaries and value coordinators. Its ethical foundation encompasses the transition from procedural informed consent to substantive empowerment, ethical proportionality in the weighing of benefits and burdens, and the responsiveness to patients’ emotional needs from the perspective of care ethics. Current practice confronts multiple dilemmas, including the cultural tension between family-dominated decision-making and patient autonomy, ethical dilemmas arising from misaligned treatment expectations and information delivery, structural communication constraints, and the scarcity of localized decision aids. Conclusion: It is recommended to establish a pre-decision mechanism grounded in values assessment, develop graphical and standardized decision aids, implement a nurse-led multidisciplinary collaborative model, and construct a continuous assessment and dynamic feedback framework throughout the entire treatment course, thereby promoting the localized implementation of shared decision-making and achieving coordinated safeguarding of patients’ decisional dignity and quality of life.