Ruiz Moral Roger, Peralta Munguia Lucía, Pérula de Torres Luis Angel, Gavilán Moral Enrique, Loayssa Lara José Ramón
Unidad Docente de Medicina de Familia, Córdoba, España.
Aten Primaria. 2010 May;42(5):257-63. doi: 10.1016/j.aprim.2009.09.020. Epub 2009 Nov 28.
This work aims to explore to what extent Spanish primary care providers involve patients in decisions and describe the development of a suggested tool for assessing patient involvement in these settings.
Cross-sectional, development of a measurement tool.
Primary care clinics.
Family doctors and residents.
Based on a review of the literature and the opinions of primary care doctors, a selection was made of items from a previous scale used to measure general communication skills (CICAA-Patient Centred) and new specific items were added to this to measure involvement.
The involvement of patients in decision-making was evaluated initially with this tool in 31 different clinical visits and the scale was then reformulated. A pool of 161 interviews was used to complete the process. Some psychometric properties (reliability and internal consistency) were estimated for the different samples and stages of the process.
Some degree of patient involvement was found in just 31 visits. Despite this, only in 18 of these (58%) was there some involvement in a discussion about more than one treatment option. The Cohen's kappa values of the CICAA-Decision scale were between 0.48 and 0.94. Cronbach's alpha was 0.60/0.51. The global Intra-class correlation coefficient was 0.96.
The levels of patient involvement were lower than expected. A simple question, such as that defined by one item in particular, and the CICAA-D scale, in general, could be useful to assess patient involvement in decision making in primary care.
本研究旨在探讨西班牙初级保健提供者在决策过程中让患者参与的程度，并描述一种用于评估患者在这些环境中参与情况的建议工具的开发过程。
横断面研究，开发测量工具。
初级保健诊所。
家庭医生和住院医生。
基于文献综述和初级保健医生的意见，从先前用于测量一般沟通技巧的量表（以患者为中心的CICAA）中选取项目，并添加新的特定项目以测量参与度。
最初使用该工具在31次不同的临床就诊中评估患者在决策中的参与度，然后对量表进行重新制定。使用161次访谈的汇总数据来完成该过程。对该过程的不同样本和阶段估计了一些心理测量特性（信度和内部一致性）。
在31次就诊中仅发现了一定程度的患者参与。尽管如此，其中只有18次（58%）在关于不止一种治疗方案的讨论中有一定参与。CICAA-决策量表的Cohen's kappa值在0.48至0.94之间。Cronbach's alpha为0.60/0.51。总体组内相关系数为0.96。
患者参与水平低于预期。一个简单的问题，例如由一个特定项目定义的问题，以及一般的CICAA-D量表，可能有助于评估初级保健中患者在决策中的参与情况。
