Morgan M W, Deber R B, Llewellyn-Thomas H A, Gladstone P, Cusimano R J, O'Rourke K, Tomlinson G, Detsky A S
The Toronto Hospital and Sunnybrook Health Science Centre Units, University of Toronto, Ontario, Canada.
J Gen Intern Med. 2000 Oct;15(10):685-93. doi: 10.1046/j.1525-1497.2000.91139.x.
To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decision-making process involving treatment choices for ischemic heart disease, on patient decision-making.
Randomized, controlled trial.
The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada.
Two hundred forty ambulatory patients with
The primary outcome was patient satisfaction with the decision-making process. This was measured using the 12-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores. Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patient-angiographer disagreement about treatment decisions.
There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decision-making autonomy without apparent impact on quality of life.
确定缺血性心脏病共同决策项目（IHD SDP），即一个旨在协助患者在涉及缺血性心脏病治疗选择的决策过程中的交互式视频光盘，对患者决策的影响。
随机对照试验。
加拿大多伦多安大略省多伦多大学的多伦多医院。
240名门诊患者
主要结局是患者对决策过程的满意度。这是使用在良性前列腺增生共同决策项目的随机试验中开发并验证过的12项决策过程问卷进行测量的。次要结局包括患者知识（使用20个关于知情治疗决策所需知识的问题进行测量）、治疗决策、患者与血管造影医师在决策上的一致性以及总体健康评分。结局在治疗决策时和/或6个月随访时进行测量。干预组和对照组的共同决策项目得分相似（分别为71%和70%；95%置信区间[CI]为差异1%，-3%至7%）。干预组的知识得分更高（75%对62%；95%CI为差异13%，8%至18%）。干预组选择进行血运重建的频率较低（对照组为58%对75%；95%CI为差异17%，4%至31%）。在6个月时，干预组的52%和对照组的66%进行了血运重建（95%CI为差异14%，0%至28%）。6个月时两组的总体健康和心绞痛评分没有差异。接触IHD SDP导致患者与血管造影医师在治疗决策上的分歧更多。
IHD SDP组和常规治疗组在决策过程满意度得分上没有显著差异。IHD SDP组的患者知识更丰富，接受的血运重建（介入治疗）更少，并且表现出患者决策自主性增加，而对生活质量没有明显影响。
