Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA.
Health Expect. 2011 Mar;14 Suppl 1(Suppl 1):58-72. doi: 10.1111/j.1369-7625.2010.00614.x.
Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care.
To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions.
Cross-sectional survey nested within a randomized CHD prevention study.
University internal medicine clinic; 24 physicians and 157 patients.
Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives.
Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making.
Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.
对于患者和医生在临床讨论内容和结果方面的一致性，人们知之甚少。对内容和结果有共同的认识可能有利于优化决策和临床护理。
确定冠心病 (CHD) 预防讨论中患者与医生之间的一致性。
在一项冠心病预防研究中嵌套的横断面调查。
大学内科诊所；24 名医生和 157 名患者。
在一次就诊后，我们调查了患者和医生对 CHD 预防讨论的内容、决策和最终决策。为了进行比较，我们对 20 次医患访谈进行了音频记录、转录和编码。我们计算了患者/医生报告、患者/转录报告和医生/转录报告之间的百分比一致性。我们计算了 Cohen's kappa 来比较患者/医生的观点。
在 130 次就诊中，患者和医生都认为讨论了 CHD（83%；kappa = 0.55；95%CI 0.40-0.70）。当讨论发生时，他们在 53%的就诊中对讨论内容（赞成与反对）达成一致（kappa = 0.15；95%CI -0.01-0.30），在 73%的就诊中对医生的建议达成一致（kappa = 0.44；95%CI 0.28-0.66）。患者和医生对服用药物的最终决定达成一致的比例为 78%（kappa = 0.58；95%CI 0.45-0.71），对改变生活方式的最终决定达成一致的比例为 69%（kappa = 0.38；95%CI 0.24-0.53）。他们在参与决策的程度上的意见不太一致，为 43%（kappa = 0.13；95%CI -0.11-0.37）。录音结果相似，但在讨论内容和决策方面，转录本与患者和医生的自我报告之间的一致性非常低。
临床讨论和决策方面的分歧可能很常见。未来需要确定：这种一致性的广泛程度；它们是否会影响临床结果；以及共享决策的主观体验与客观步骤的相对重要性。
