Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St, Michael's, Toronto, Ontario, Canada.
BMC Musculoskelet Disord. 2011 May 9;12:92. doi: 10.1186/1471-2474-12-92.
Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture.
A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology.
21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date.
Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients' decisions and monitor patients' decisions over time.
患者的价值观和偏好是循证实践的基本原则，但目前的骨质疏松症 (OP) 临床指南在治疗决策中很少关注这些问题。这可能部分是因为很少有研究检查影响患者最初决定服用 OP 药物的因素。我们的研究目的是检查患者在发生骨折后服用 OP 药物的决定的体验。
对大学教学医院骨折门诊 OP 项目中确定的门诊患者进行了现象学定性研究。年龄在 65 岁及以上、5 年内发生脆性骨折、未来骨折风险高且开处方服用 OP 药物的患者符合条件。访谈数据分析遵循 Giorgi 的方法。
21 名患者（6 名男性，15 名女性）年龄在 65-88 岁之间。所有参与者的骨量均较低；9 人患有 OP。14 名患者服用双膦酸盐，7 名患者未服用 OP 药物。对于 12 名参与者，服用 OP 药物的决定发生在开处方时，几乎没有考虑（12 名中有 10 名正在服用药物）。这些患者做出决定是因为他们喜欢/信任他们的医疗保健提供者。然而，该组中的 4/10 名参与者表示他们的 OP 药物服用状态可能会改变。对于其余 9 名患者，这个决定更加困难（9 名中有 4 名正在服用药物）。这些患者对他们的医疗保健提供者表示怀疑，使用其他信息来源进行风险效益分析，并对副作用表示担忧；7/9 名患者表示他们的 OP 药物服用状态可能会在以后改变。
我们的大多数老年患者在发生骨折后发现服用 OP 药物的决定很困难。一般来说，这个决定不被认为是永久性的。医疗保健提供者应该意识到他们在患者决策中的潜在作用，并随着时间的推移监测患者的决策。
