Guimond Pierrette, Bunn Helen, O'Connor Annette M, Jacobsen Mary Jane, Tait Valerie K, Drake Elizabeth R, Graham Ian D, Stacey Dawn, Elmslie Tom
Faculty of Health Sciences, School of Nursing, University of Ottawa, Ont., Canada.
Patient Educ Couns. 2003 Jul;50(3):235-45. doi: 10.1016/s0738-3991(03)00043-0.
As patients become more involved in decisions affecting their health, it is important to monitor and improve the support clinicians provide to facilitate shared decision making. The Decision Support Analysis Tool (DSAT) was developed as a research tool to evaluate practitioners' use of decision support and related communication skills during a clinical encounter. The DSAT, consisting of six categories of decision support skills and four categories of communication skills, was tested with 34 actual transcripts of patient-physician dialogue. The patients were prepared for the clinical encounter with either a detailed decision aid plus worksheet (n=16) or a pamphlet (n=18). Pairs of raters, blinded to the intervention allocation, coded each transcript independently. The overall inter-rater agreement and kappa coefficients were, respectively 75% and 0.59 for the decision support skills and 76% and 0.68 for the communication skills categories. The frequency of DSAT skills coded: (a) were significantly correlated with three out of six patient and physician outcome measures (r>0.30, P<0.05); and (b) showed significant discrimination (P=0.05) or trends (P<0.15) in discrimination between the decision aid and pamphlet groups. The DSAT shows promise as a reliable and valid evaluation tool but requires further testing with larger samples.
随着患者越来越多地参与影响自身健康的决策，监测并改善临床医生为促进共同决策所提供的支持变得很重要。决策支持分析工具（DSAT）作为一种研究工具而开发，用于评估从业者在临床会诊期间对决策支持及相关沟通技巧的运用。DSAT由六类决策支持技巧和四类沟通技巧组成，使用34份医患对话的实际文字记录进行了测试。患者在临床会诊前，一组使用详细的决策辅助工具加工作表（n = 16），另一组使用宣传册（n = 18）。对评分者进行干预分配盲法处理，让他们各自独立对每份文字记录进行编码。决策支持技巧方面，评分者间的总体一致性和kappa系数分别为75%和0.59，沟通技巧类别方面则分别为76%和0.68。DSAT技巧编码的频率：（a）与六项患者和医生结局指标中的三项显著相关（r>0.30，P<0.05）；（b）在决策辅助工具组和宣传册组之间显示出显著的区分度（P = 0.05）或区分趋势（P<0.15）。DSAT显示出有望成为一种可靠且有效的评估工具，但需要用更大的样本进一步测试。
