Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany.
Implement Sci. 2011 Jul 7;6:70. doi: 10.1186/1748-5908-6-70.
Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options.
The electronic library of decision aids (arriba-lib) to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses.
Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision.
Shared decision making with our multi-modular electronic library of decision aids (arriba-lib) was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be used for patient groups with a wide range of individual characteristics.
基于共享决策哲学的决策辅助工具旨在通过提供有关选择和结果的循证信息，帮助患者在诊断或治疗方案中做出明智的选择。患者决策辅助工具可以被视为一种复杂的干预措施，因为它由几个可能相关的组成部分组成。决策辅助工具很少经过现场测试来评估患者和医生对它们的态度。也不清楚决策辅助工具对选择方案的坚持程度有什么影响。
临床环境中使用的电子决策辅助库（arriba-lib）具有模块化结构，包含以下主题的循证决策辅助工具：心血管预防、心房颤动、冠心病、口服抗糖尿病药、常规和强化胰岛素治疗以及单相抑郁症。我们进行了一项评估研究，其中 29 名初级保健医生纳入了 192 名患者。咨询后，患者填写问卷，并在两个月后通过电话接受采访。我们使用广义估计方程来衡量患者变量内的关联，并进行传统的交叉表分析。
患者对 arriba-lib 和共享决策过程非常满意。在电话采访中联系到的患者中有三分之二希望再次使用 arriba-lib 进行咨询。偏好和感知的决策之间存在高度一致性。在接受电话采访的患者中，80.7%表示他们独立于性别和教育程度实施了该决策。老年患者更有可能说他们实施了该决策。
我们的多模块电子决策辅助库（arriba-lib）的共享决策被大量患者接受。它与患者决策的一般方面有积极的关联。它可以用于具有广泛个体特征的患者群体。
