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Abstract
Patient-centered care, which is a fundamental component of practicing integrative medicine, places the patient at the center of the delivery of care, improves the continuity of care, and enhances the integration of health professionals and patients. The purpose of this article is to develop a multi-person, multi-attribute model for patient-centered decision-making. Collaborative decision information provided by patients, relatives (family and friends), and healthcare providers is inherently imprecise and involves many uncertainties. Interval type-2 fuzzy sets have a greater ability than ordinary fuzzy sets to handle imprecision and imperfect information in real-world therapeutic applications. In light of patient-centeredness, this article presents a signed distance-based method for handling a collaborative decision-making problem in which individual assessments are provided as interval type-2 trapezoidal fuzzy numbers, and the preference information about attributes is only partially known. Concerning the relative importance of decision makers and group consensus regarding fuzzy opinions, all individual decision opinions are aggregated into group opinions using a hybrid average with weighted averaging and signed distance-based ordered weighted averaging operations. An integrated programming model is developed to estimate attribute weights and to order the priorities of various treatment options based on signed distances, where some deviation variables are introduced to mitigate the inconsistent evaluations. Finally, the feasibility and the effectiveness of the proposed methods are illustrated by a practical example of cancer care.
以病人為中心之照護是將病人當成一個獨特的個體 ， 瞭解和參與病人及其家屬在醫療上的決策與自我管理 ， 協助整合與協調 ， 且有助於改善臨床實務上之醫病關係。 本研究之目的係為發展以病人為中心之決策的多人多屬性模式。 牽涉醫護人員、 病人及其家屬等多位參與者之群體決策問題複雜性相當高 ， 且以病人為中心之照護理念中所考慮的屬性經常彼此矛盾或衝突。 再加上問題本身之模糊性、 不精確與不確定性 ， 導致屬性權重或方案評估值甚難以明確數字判定 ， 故本研究引入區間型二模糊集合理論 ， 發展基於符號距離之病人中心的協同決策方法。 其中 ， 本研究使用區間型二梯形模糊數作為決策方案的評估績效值 ， 並處理不完整甚或不一致的屬性重要性資訊。 本研究同時考量決策者重要性與意見共識度 ， 發展綜合加權平均與以符號距離為基礎之順序加權平均的混合平均運算 ， 以整合群體意見。 結合不完整屬性重要性資訊後 ， 本研究建立整合型規劃模式 ， 以推估屬性的最佳權重值 ， 並界定方案之優先順序。 最後 ， 本研究以癌症照護實例驗證研提方法之可行性與有效性。
(*聯絡人： [email protected])
Acknowledgements
The author is very grateful to the editor and the anonymous referees for their insightful and constructive comments, which helped improve the overall quality of this article. This research is financially supported by the National Science Council of Taiwan (Grant Nos NSC 99-2410-H-182-022-MY3 and NSC 100-2632-H-182-001-MY2).
Notes
(*聯絡人： [email protected])