Kumar Rashmi, Korthuis P Todd, Saha Somnath, Chander Geetanjali, Sharp Victoria, Cohn Jonathon, Moore Richard, Beach Mary Catherine
Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205, USA.
J Gen Intern Med. 2010 Jun;25(6):517-23. doi: 10.1007/s11606-010-1275-3. Epub 2010 Feb 24.
A preference for shared decision-making among patients with HIV has been associated with better health outcomes. One possible explanation for this association is that patients who prefer a more active role in decision-making are more engaged in the communication process during encounters with their providers. Little is known, however, about patient and provider characteristics or communication behaviors associated with patient decision-making preferences in HIV settings.
We examined patient and provider characteristics and patient-provider communication behaviors associated with the decision-making role preferences of patients with HIV.
Cross-sectional analysis of patient and provider questionnaires and audio recorded clinical encounters from four sites.
A total of 45 providers and 434 of their patients with HIV.
Patients were asked how they prefer to be involved in the decision-making process (doctor makes all/most decisions, patients and doctors share decisions, or patients make decisions alone). Measures of provider and patient communication behaviors were coded from audio recordings using the Roter Interaction Analysis System.
Overall, 72% of patients preferred to share decisions with their provider, 23% wanted their provider to make decisions, and 5% wanted to make decisions themselves. Compared to patients who preferred to share decisions with their provider, patients who preferred their provider make decisions were less likely to be above the age of 60 (ARR 0.09, 95% CI 0.01-0.89) and perceive high quality provider communication about decision-making (ARR 0.41, 95% CI 0.23-0.73), and more likely to have depressive symptoms (ARR 1.92, 95% CI 1.07-3.44). There was no significant association between patient preferences and measures of provider or patient communication behavior.
Observed measures of patient and provider communication behavior were similar across all patient decision-making role preferences, indicating that it may be difficult for providers to determine these preferences based solely on communication behavior. Engaging patients in open discussion about decision-making preferences may be a more effective approach.
HIV患者对共同决策的偏好与更好的健康结果相关。这种关联的一种可能解释是，在与医疗服务提供者接触期间，更喜欢在决策中发挥更积极作用的患者在沟通中参与度更高。然而，在HIV环境中，关于与患者决策偏好相关的患者和医疗服务提供者特征或沟通行为知之甚少。
我们研究了与HIV患者决策角色偏好相关的患者和医疗服务提供者特征以及医患沟通行为。
对来自四个地点的患者和医疗服务提供者问卷以及音频记录的临床会诊进行横断面分析。
共有45名医疗服务提供者及其434名HIV患者。
询问患者他们希望如何参与决策过程（医生做出所有/大多数决策、患者和医生共同决策或患者独自决策）。使用罗特尔互动分析系统从音频记录中对医疗服务提供者和患者沟通行为的测量进行编码。
总体而言，72%的患者希望与医疗服务提供者共同决策，23%希望医疗服务提供者做出决策，5%希望自己做出决策。与希望与医疗服务提供者共同决策的患者相比，希望医疗服务提供者做出决策的患者年龄在60岁以上的可能性较小（风险比0.09，95%置信区间0.01 - 0.89），并且认为医疗服务提供者关于决策的沟通质量高的可能性较小（风险比0.41，95%置信区间0.23 - 0.73），而出现抑郁症状的可能性更大（风险比1.92，95%置信区间1.07 - 3.44）。患者偏好与医疗服务提供者或患者沟通行为的测量之间没有显著关联。
在所有患者决策角色偏好中，观察到的患者和医疗服务提供者沟通行为测量结果相似，这表明医疗服务提供者可能难以仅根据沟通行为来确定这些偏好。让患者参与关于决策偏好的开放讨论可能是一种更有效的方法。
