HealthPartners, HealthPartners Medical Group, and HealthPartners Research Foundation, Minneapolis, Minnesota 55440-1524, USA.
Med Decis Making. 2010 Jul-Aug;30(4):444-52. doi: 10.1177/0272989X09353947. Epub 2009 Nov 30.
There is limited evidence about how to ensure that patients are helped to make informed medical care decisions.
To test a decision support intervention for uterine fibroid treatments.
Practical clinical trial to test informed choice assistance in 4 randomly assigned gynecology clinics compared to 5 others providing a pamphlet.
Three hundred women facing a treatment decision for fibroids over a 13-month period.
Mailed DVD and brochure about fibroid treatments plus the Ottawa decision guide and an offer of counseling soon after an index visit.
Mailed survey 6 to 8 weeks later asking about knowledge, preferences, and satisfaction with decision support.
In total, 244 surveys were completed for an adjusted response rate of 85.4%. On a 5-point scale, intervention subjects reported more treatment options being mentioned (3.0 v. 2.4), had a higher knowledge score (3.3 v. 2.8), and were more likely to report being adequately informed (4.4 v. 4.0), and their decision was both more satisfactory (4.3 v. 4.0) and more consistent with their personal values (4.5 v. 4.2). Neither knowledge nor use of the intervention was associated with greater concordance between preferences and decisions.
Implementation of intervention may not have been well timed to the decision for some patients, limiting their use of the materials and counseling.
It is difficult to integrate structured decision support consistently into practice. Decision support for benign uterine conditions showed effects on knowledge and satisfaction but not on concordance.
关于如何确保帮助患者做出明智的医疗决策，证据有限。
测试针对子宫肌瘤治疗的决策支持干预措施。
在 4 个随机分配的妇科诊所进行的实用临床试验，与提供宣传册的 5 个其他诊所相比，测试知情选择辅助治疗。
在 13 个月的时间里，有 300 名面临子宫肌瘤治疗决策的女性。
邮寄 DVD 和有关子宫肌瘤治疗的小册子，外加奥塔哥决策指南，并在索引访问后不久提供咨询服务。
在 6 到 8 周后邮寄调查，询问有关决策支持的知识、偏好和满意度。
共有 244 份调查完成，调整后的回复率为 85.4%。在 5 分制上，干预组报告提到的治疗方案更多（3.0 比 2.4），知识得分更高（3.3 比 2.8），更有可能报告充分知情（4.4 比 4.0），并且他们的决策更令人满意（4.3 比 4.0），并且更符合他们的个人价值观（4.5 比 4.2）。无论是知识还是干预的使用，都与偏好和决策之间的一致性增加无关。
对于一些患者来说，干预措施的实施可能没有及时与决策相匹配，限制了他们对材料和咨询的使用。
将结构化决策支持系统一致地融入实践中很困难。针对良性子宫疾病的决策支持在知识和满意度方面产生了影响，但对一致性没有影响。
