【摘要】 以叙事医学工具反思性写作为切入点，首先从医方、患方及外部环境三个角度分析了当前医患共同决策所面临的临床实践困境，其次在对反思性写作概念、实践特点概述的基础上，提出了叙事能力对临床工作的重要性、叙事医学伦理对决策困境的作用，最后从促使医方自我反思，避免引导式决策及权威主义；弥合医患视阈差异，达成决策共识；阐明并澄清患者偏好及价值观，促进个体化共同决策；提高患者参与决策意愿，调动参与决策积极性；缓和医患关系，实现医患共情，促进共同决策良性互动五个方面阐述了反思性写作对医患共同决策困境的助力作用。更多还原

【Abstract】 Using reflective narrative writing as a starting point, this study first analyzes the clinical practice dilemma faced by the current shared decision-making from the perspectives of doctors, patients and external environments. Following an overview of the concept and practice characteristics of reflective writing, it puts forward the importance of narrative competence in clinical work and the role of narrative medical ethics in decision-making dilemma. The study concludes by elucidating the supportive role of reflective writing in addressing challenges in shared decision-making: prompting self-reflection among healthcare providers, avoiding directive decision-making and authoritarianism; bridging differences in perspectives between patients and doctors to achieve a consensus on decision-making; elucidating and clarifying patient preferences and values to promote individualized shared decision-making; improving patient willingness to participate in decision-making, mobilizing the enthusiasm for participation in decision-making; easing patient-physician relationship to enhance empathy, and fostering positive interactions.更多还原