Adams R J, Smith B J, Ruffin R E
Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia.
Thorax. 2001 Feb;56(2):126-32. doi: 10.1136/thorax.56.2.126.
Lower patient preferences for autonomy in management decision making during asthma exacerbations have been associated with an increased risk for future hospital admissions. We sought to examine patient preferences for asthma self-management autonomy, and the clinical and psychosocial factors associated with autonomy preferences.
A cross sectional observational study was performed with data collected between June 1995 and December 1997 of 212 adult patients with moderate to severe asthma managed, at least in part, at two teaching hospitals. Subjects completed a survey of autonomy preferences, quality of life, clinical morbidity and health service use, asthma knowledge, self-efficacy, coping styles, and psychosocial measures.
Patients preferred clinicians to assume the major role in most decision making about their management. However, patients wished to remain in control in choosing when to seek care and wanted to share decisions regarding initiating changes in medications during a moderate exacerbation. Multiple regression analysis showed that concerns about adverse effects of medications, education level, an active coping style, perceptions of the propensity of physicians to involve them in treatment decision making, and concerns about costs causing delays in seeking medical care were associated with preferences for autonomy in decision making. Autonomy preferences were not related to measures of concurrent clinical asthma control or health related quality of life.
In a group of patients with moderate to severe asthma, a high proportion of whom were from socioeconomically disadvantaged backgrounds, education level, perceived physician behaviour, cost barriers to care, and psychosocial factors (but not clinical asthma control or management) were related to patient preferences for autonomy in management decision making during asthma exacerbations. This has implications for asthma action plans and design of self-management programmes.
在哮喘加重期，患者对管理决策自主权的偏好较低与未来住院风险增加有关。我们试图研究患者对哮喘自我管理自主权的偏好，以及与自主权偏好相关的临床和心理社会因素。
进行了一项横断面观察性研究，收集了1995年6月至1997年12月期间在两家教学医院接受管理（至少部分接受管理）的212例中重度成年哮喘患者的数据。受试者完成了一项关于自主权偏好、生活质量、临床发病率和医疗服务使用、哮喘知识、自我效能感、应对方式和心理社会指标的调查。
患者希望临床医生在大多数关于其治疗的决策中承担主要角色。然而，患者希望在选择何时寻求治疗方面保持控制权，并希望在中度加重期就启动药物变化的决策进行分享。多元回归分析表明，对药物不良反应的担忧、教育水平、积极的应对方式、对医生让他们参与治疗决策倾向的看法，以及对费用导致就医延迟的担忧与决策自主权偏好有关。自主权偏好与同期临床哮喘控制或健康相关生活质量指标无关。
在一组中重度哮喘患者中，其中很大一部分来自社会经济弱势背景，教育水平、感知到的医生行为、医疗费用障碍和心理社会因素（而非临床哮喘控制或管理）与哮喘加重期患者对管理决策自主权的偏好有关。这对哮喘行动计划和自我管理项目的设计具有启示意义。
