决策支持干预对微卫星不稳定性检测相关决策冲突的影响。
Effects of a decision support intervention on decisional conflict associated with microsatellite instability testing.
机构信息
Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
出版信息
Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):249-54. doi: 10.1158/1055-9965.EPI-10-0685. Epub 2011 Jan 6.
BACKGROUND
Decision support to facilitate informed consent is increasingly important for complicated medical tests. Here, we test a theoretical model of factors influencing decisional conflict in a study examining the effects of a decision support aid that was designed to assist patients at high risk for hereditary nonpolyposis colorectal cancer (CRC) deciding whether to pursue the microsatellite instability (MSI) test.
METHODS
Participants were 239 CRC patients at high familial risk for a genetic mutation who completed surveys before and after exposure to the intervention. Half of the sample was assigned to the CD-ROM aid and half received a brief description of the test. Structural equation modeling was employed to examine associations among the intervention, knowledge, pros and cons to having MSI testing, self-efficacy, preparedness, and decisional conflict.
RESULTS
The goodness of fit for the model was acceptable [FIML, full information maximum likelihood, χ(2) (df = 280) = 392.24; P = 0.00]. As expected, the paths to decisional conflict were significant for postintervention pros of MSI testing (t = -2.43; P < 0.05), cons of MSI testing (t = 2.78; P < 0.05), and preparedness (t = -7.27; P < 0.01). The intervention impacted decisional conflict by increasing knowledge about the MSI test and knowledge exerted its effects on decisional conflict by increasing preparedness to make a decision about the test and by increases in perceived benefits of having the test.
CONCLUSION
Increasing knowledge, preparedness, and perceived benefits of undergoing the MSI test facilitate informed decision making for this test.
IMPACT
Understanding mechanisms underlying health decisions is critical for improving decisional support. Individuals with Lynch syndrome have an elevated lifetime risk of CRC. Risk of Lynch syndrome may be assessed with a tumor-based screening test (MSI testing or immunohistochemical tissue staining).
背景
为复杂的医学测试提供决策支持以促进知情同意，这一点变得越来越重要。在这里，我们检验了一个理论模型，该模型研究了旨在帮助遗传性非息肉病性结直肠癌（CRC）高危患者决定是否进行微卫星不稳定性（MSI）检测的决策支持辅助工具的影响，以此来检验影响决策冲突的因素。
方法
参与者是 239 名有 CRC 家族遗传高危风险的患者，他们在接受干预措施前后完成了调查。样本的一半被分配到 CD-ROM 辅助工具，另一半则收到了对测试的简要描述。结构方程模型被用于检验干预措施、知识、进行 MSI 检测的利弊、自我效能、准备度和决策冲突之间的关联。
结果
模型的拟合优度良好[FIML，完全信息最大似然法，χ(2)（df = 280）= 392.24；P = 0.00]。正如预期的那样，干预措施与 MSI 检测的后验优势（t = -2.43；P < 0.05）、MSI 检测的劣势（t = 2.78；P < 0.05）和准备度（t = -7.27；P < 0.01）之间的路径具有显著意义。干预措施通过增加对 MSI 检测的了解来影响决策冲突，而知识则通过增加对进行 MSI 检测决策的准备程度和增加对检测的益处感知来对决策冲突产生影响。
结论
增加对 MSI 检测的了解、准备度和益处感知有助于做出关于该检测的知情决策。
影响
了解健康决策的机制对于改善决策支持至关重要。林奇综合征患者一生中患 CRC 的风险较高。林奇综合征的风险可以通过肿瘤基础的筛查检测（MSI 检测或免疫组织化学组织染色）进行评估。
Zotero 插件