你确定吗？：使用 4 项筛查测试评估患者的决策冲突。
Are you SURE?: Assessing patient decisional conflict with a 4-item screening test.
机构信息
Department of Family Medicine at Laval University in Quebec city, Que.
出版信息
Can Fam Physician. 2010 Aug;56(8):e308-14.
OBJECTIVE
To assess the reliability and validity of the 4-item SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test for decisional conflict in patients.
DESIGN
Cross-sectional study.
SETTING
Four family medicine groups in Quebec and 1 rural academic medical centre in New Hampshire.
PARTICIPANTS
One hundred twenty-three French-speaking pregnant women considering prenatal screening for Down syndrome and 1474 English-speaking patients referred to watch condition-specific video decision aids.
MAIN OUTCOME MEASURES
Cronbach alpha was used to assess the reliability of SURE. A factorial analysis was performed to assess its unidimensionality. The Pearson correlation coefficient was computed between SURE and the Decisional Conflict Scale to assess concurrent validation. A t test procedure comparing the SURE scores of patients who had made decisions with the scores of those who had not was used to assess construct validation.
RESULTS
Among the 123 French-speaking pregnant women, 105 (85%) scored 4 out of 4 (no decisional conflict); 10 (8%) scored 3 (<or= 3 indicates decisional conflict); 7 (6%) scored 2; and 1 (1%) scored 1. Among the 1474 English-speaking treatment-option patients, 981 (67%) scored 4 out of 4; 272 (18%) scored 3; 147 (10%) scored 2; 54 (4%) scored 1; and 20 (1%) scored 0. The reliability of SURE was moderate (Cronbach alpha of 0.54 in French-speaking pregnant women and 0.65 in treatment-option patients). In the group of pregnant women, 2 factors accounted for 72% of the variance. In the treatment-option group, 1 factor accounted for 49% of the variance. In the group of pregnant women, SURE correlated negatively with the Decisional Conflict Scale (r = -0.46; P < .0001); and in the group of treatment-option patients, it discriminated between those who had made a choice for a treatment and those who had not (P < .0001).
CONCLUSION
The SURE screening test shows promise for screening for decisional conflict in both French- and English-speaking patients; however, future studies should assess its performance in a broader group of patients.
目的
评估 4 项 SURE（对自己有信心；了解信息；风险-效益比；鼓励）筛选测试在患者决策冲突中的可靠性和有效性。
设计
横断面研究。
设置
魁北克的四个家庭医学组和新罕布什尔州的一个农村学术医疗中心。
参与者
123 名说法语的孕妇考虑进行唐氏综合征产前筛查，以及 1474 名被转诊观看特定疾病视频决策辅助工具的英语患者。
主要结果测量
Cronbach α 用于评估 SURE 的可靠性。进行因子分析以评估其单维性。Pearson 相关系数用于评估 SURE 与决策冲突量表之间的同时验证。t 检验程序用于比较做出决策的患者的 SURE 评分与未做出决策的患者的评分，以评估结构验证。
结果
在 123 名说法语的孕妇中，有 105 名（85%）得分为 4 分（无决策冲突）；10 名（8%）得分为 3 分（<=3 分表示决策冲突）；7 名（6%）得分为 2 分；1 名（1%）得分为 1 分。在 1474 名接受治疗选择的患者中，有 981 名（67%）得分为 4 分；272 名（18%）得分为 3 分；147 名（10%）得分为 2 分；54 名（4%）得分为 1 分；20 名（1%）得分为 0 分。SURE 的可靠性为中度（说法语的孕妇为 0.54，接受治疗选择的患者为 0.65）。在孕妇组中，2 个因素占方差的 72%。在治疗选择组中，1 个因素占方差的 49%。在孕妇组中，SURE 与决策冲突量表呈负相关（r = -0.46；P<.0001）；在治疗选择患者组中，它区分了已经做出治疗选择的患者和未做出选择的患者（P<.0001）。
结论
SURE 筛选测试在说法语和英语患者中均显示出用于筛选决策冲突的潜力；然而，未来的研究应该在更广泛的患者群体中评估其性能。
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