Nannenga Michael R, Montori Victor M, Weymiller Audrey J, Smith Steven A, Christianson Teresa J H, Bryant Sandra C, Gafni Amiram, Charles Cathy, Mullan Rebecca J, Jones Lesley A, Bolona Enrique R, Guyatt Gordon H
Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Health Expect. 2009 Mar;12(1):38-44. doi: 10.1111/j.1369-7625.2008.00521.x.
Decision aids in practice may affect patient trust in the clinician, a requirement for optimal diabetes care. We sought to determine the impact of a decision aid to help patients with diabetes decide about statins (Statin Choice) on patients' trust in the clinician.
We randomized 16 diabetologists and 98 patients with type 2 diabetes referred to a subspecialty diabetes clinic to use the Statin Choice decision aid or a patient pamphlet about dyslipidaemia, and then to receive these materials from either the clinician during the visit or a researcher prior to the visit. Providers and patients were blinded to the study hypothesis. Immediately after the clinical encounter, patients completed a survey including questions on trust (range 0 to total trust = 100), knowledge, and decisional conflict. Researchers reviewed videotaped encounters and assessed patient participation (using the OPTION scale) and visit length.
Overall mean trust score was 91 (median 97.2, IQR 86, 100). After adjustment for patient characteristics, results suggested greater total trust (trust = 100) with the decision aid [odds ratio (OR) 1.77, 95% CI 0.94, 3.35]. Total trust was associated with knowledge (for each additional knowledge point, OR 1.3, 95% CI 1.1, 1.6), patient participation (for each additional point in the OPTION scale, OR 1.1, 95% CI 1.1, 1.2), and decisional conflict (for every 5-point decrease in conflict, OR 1.5, 95% CI 1.2, 1.9). Total trust was not associated with visit length, which the decision aid did not significantly affect. There was no significant effect interaction across the trial factors.
Preliminary evidence suggests that decision aids do not have a large negative impact on trust in the physician and may increase trust through improvements in the decision-making process.
实践中的决策辅助工具可能会影响患者对临床医生的信任，而这是优化糖尿病护理的一项要求。我们试图确定一种帮助糖尿病患者决定是否使用他汀类药物的决策辅助工具（他汀类药物选择）对患者对临床医生信任的影响。
我们将16名糖尿病专家和98名转诊至糖尿病专科诊所的2型糖尿病患者随机分组，分别使用他汀类药物选择决策辅助工具或一本关于血脂异常的患者宣传册，然后在就诊期间由临床医生提供这些材料，或在就诊前由研究人员提供。提供者和患者对研究假设不知情。临床接触结束后，患者立即完成一项调查，包括关于信任（范围为0至完全信任=100）、知识和决策冲突的问题。研究人员查看了录像的接触过程，并评估了患者的参与度（使用OPTION量表）和就诊时长。
总体平均信任得分为91分（中位数97.2，四分位间距86,100）。在对患者特征进行调整后，结果表明使用决策辅助工具时总体信任度更高（信任=100）[优势比（OR）1.77，95%置信区间0.94,3.35]。总体信任与知识相关（每增加一个知识要点，OR 1.3，95%置信区间1.1,1.6）、患者参与度相关（在OPTION量表上每增加一分，OR 1.1，95%置信区间1.1,1.2）以及决策冲突相关（冲突每减少5分，OR 1.5，95%置信区间1.2,1.9）。总体信任与就诊时长无关，决策辅助工具对就诊时长没有显著影响。在各试验因素之间没有显著的效应交互作用。
初步证据表明，决策辅助工具对医生信任没有很大的负面影响，并且可能通过改善决策过程来增加信任。
