HealthPartners, HealthPartners Medical Group, and HealthPartners Research Foundation, Minneapolis, Minnesota 55440-1524, USA.
J Womens Health (Larchmt). 2009 Jul;18(7):1071-9. doi: 10.1089/jwh.2008.0948.
Preference-sensitive care decisions should reflect an informed patient's preferences. This retrospective survey of women with fibroids, a benign condition with multiple treatment options, sought to evaluate the extent to which this was measurable and true.
All 260 women in one medical group with visit codes for uterine fibroids during a 9-month period in 2006 were mailed surveys constructed through focus groups with physicians and interviews with patients. Correlations tested associations among their preferences, knowledge, and treatment decisions.
The adjusted response rate was 82%, but only 100 respondents fit all criteria for analysis. Nearly all wanted to either share or control the decision, and 86% felt informed, satisfied, and that the decision was consistent with their values. However, only 55% of patients could answer at least five of seven fibroid questions correctly. Hysterectomy use was significantly correlated with desire to relieve symptoms, have a permanent treatment, and do something right away (r = 0.36, 0.37, and 0.30, respectively). Those deciding not to treat were significantly less likely to have these preferences (r = -0.65, -0.40, and -0.58). These relationships were not affected by patient knowledge level, but patients with high knowledge scores were significantly more likely to believe their decision was concordant with their preferences (94.9% vs. 74.4%, p < 0.01).
There were knowledge gaps but unclear associations between knowledge and decision-preference relationships for this condition, which has many different treatment alternatives. A prospective intervention trial is needed to determine if better information and counseling would produce stronger concordance between treatment selected and patient preferences.
偏好敏感的护理决策应反映出知情患者的偏好。本研究回顾性调查了患有子宫肌瘤的女性，这是一种具有多种治疗选择的良性疾病，旨在评估其可衡量性和真实性。
2006 年 9 个月期间，某医疗组的 260 名患有子宫肌瘤的女性，其就诊代码被列入调查范围。通过与医生的焦点小组讨论以及对患者的访谈，设计了邮寄调查问卷。相关性检验了她们的偏好、知识和治疗决策之间的关联。
调整后的应答率为 82%，但只有 100 名符合所有分析标准的受访者。几乎所有的女性都希望参与或控制决策，86%的女性感到知情、满意且决策符合她们的价值观。然而，只有 55%的患者能正确回答七个子宫肌瘤问题中的至少五个。子宫切除术的使用与缓解症状、寻求永久性治疗和立即采取行动的愿望显著相关（r 值分别为 0.36、0.37 和 0.30）。那些决定不治疗的患者这些偏好的可能性显著降低（r 值分别为-0.65、-0.40 和-0.58）。这些关系不受患者知识水平的影响，但高知识评分的患者更有可能认为他们的决策与他们的偏好一致（94.9%对 74.4%，p<0.01）。
对于这种有多种治疗选择的疾病，尽管存在知识差距，但知识与决策-偏好关系之间的关联并不明确。需要进行前瞻性干预试验，以确定更好的信息和咨询是否会使所选治疗与患者偏好之间产生更强的一致性。
