Stacey D, Menard P, Gaboury I, Jacobsen M, Sharif F, Ritchie L, Bunn H
School of Nursing, University of Ottawa, Ottawa, ON, Canada.
J Psychiatr Ment Health Nurs. 2008 May;15(4):287-95. doi: 10.1111/j.1365-2850.2007.01224.x.
The study's purpose was to explore the decision-making needs of patients considering treatment options for their depression. Semi-structured interviews were guided by the Ottawa Decision Support Framework. Of 94 participants, 67 were uncertain about their decision. Common decisions identified were whether or not to take medications, attend support groups, undergo electroconvulsive therapy, and location of care. Those feeling certain were more likely to have made a decision (RR 1.37; 95% CI: 1.05, 1.78). However, 40 patients who had 'made a decision' in the recent past were uncertain about their decision. Compared with those who were certain, the uncertain group felt less informed (2.65 vs. 1.64; P < 0.001), less supported (2.63 vs. 1.88; P < 0.001) and less clear about how they valued the benefits and risks of options (2.57 vs. 1.69; P < 0.001). Other influential factors included concerns about confidentiality, distress from depression, embarrassment, panic attacks and lack of energy. Few patients wanted to defer decision making to their physician (n = 8) or family (n = 1). To support decision making, participants identified the need for: discussions with their psychiatrist, nurse or family doctor; access to printed information; and information provided by health professionals and health societies.
该研究的目的是探讨考虑抑郁症治疗方案的患者的决策需求。半结构化访谈以渥太华决策支持框架为指导。在94名参与者中，67人对自己的决策不确定。确定的常见决策包括是否服药、参加支持小组、接受电休克治疗以及护理地点。感觉确定的人更有可能已经做出了决定（相对危险度1.37；95%置信区间：1.05，1.78）。然而，最近“做出决定”的40名患者对自己的决定并不确定。与确定的人相比，不确定的人群感觉了解的信息更少（2.65对1.64；P<0.001），得到的支持更少（2.63对1.88；P<0.001），并且对如何权衡选择的益处和风险不太清楚（2.57对1.69；P<0.001）。其他影响因素包括对保密性的担忧、抑郁症带来的痛苦、尴尬、惊恐发作和缺乏精力。很少有患者想把决策推迟给他们的医生（8人）或家人（1人）。为了支持决策，参与者确定需要：与他们的精神科医生、护士或家庭医生进行讨论；获取印刷信息；以及由卫生专业人员和卫生协会提供的信息。
