Geriatric Department, Vrinnevi Hospital, Gamla Ö vägen 25, 601 82 Norrköping, Sweden.
BMC Geriatr. 2011 Aug 18;11:46. doi: 10.1186/1471-2318-11-46.
Medical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the role elderly people with co-morbidities wish to assume and actually had with regard to information and participation in medical decision making during their last stay in hospital.This study was a cross-sectional survey including three Swedish hospitals with acute admittance. The participants were patients aged 75 years and above with three or more diagnoses according to the International Classification of Diseases (ICD-10) and three or more hospitalisations during the last year.
We used a questionnaire combined with a telephone interview, using the Control Preference Scale to measure each participant's preferred and actual role in medical decision making during their last stay in hospital. Additional questions were asked about barriers to participation in decision making and preferred information seeking role. The results are presented with descriptive statistics with kappa weights.
Of the 297 elderly patients identified, 52.5% responded (n = 156, 46.5% male). Mean age was 83.1 years. Of the respondents, 42 of 153 patients said that they were not asked for their opinion (i.e. no shared decision making). Among the other 111 patients, 49 had their exact preferred level of participation, 37 had less participation than they would have preferred, and 23 had more responsibility than they would have preferred. Kappa statistics showed a moderate agreement between preferred and actual role (κw = 0.57; 95% CI: 0.45-0.69). Most patients wanted to be given more information without having to ask. There was no correlation between age, gender, or education and preferred role. 35% of the patients agreed that they experienced some of the various barriers to decision making that they were asked about: 1) the severity of their illness, 2) doctors with different treatment strategies, 3) difficulty understanding the medical information, and 4) difficulty understanding doctors who did not speak the patient's own language.
Physicians are not fully responsive to patient preferences regarding either the degree of communication or the patient's participation in decision making. Barriers to participation can be a problem, and should be taken into account more often when dealing with hospitalised elderly people.
医学决策一直是关注的焦点，但对于患有合并症的老年人参与医学决策的偏好和条件知之甚少。本研究的主要目的是调查老年人在最后一次住院期间对信息和参与医疗决策的期望控制程度和实际控制程度，即他们希望承担的角色和实际承担的角色。这项研究是一项横断面调查，包括瑞典的三家急性入院医院。参与者是年龄在 75 岁及以上的患者，根据《国际疾病分类》（ICD-10）有三个或三个以上诊断，在过去一年中有三个或三个以上的住院记录。
我们使用问卷结合电话访谈，使用控制偏好量表来衡量每位参与者在最后一次住院期间对医疗决策的期望控制程度和实际控制程度。还询问了参与决策的障碍和首选信息寻求角色的问题。结果以描述性统计和 Kappa 权重表示。
在确定的 297 名老年人中，有 52.5%（n=156，46.5%为男性）做出了回应。平均年龄为 83.1 岁。在回答者中，有 42 名（占 153 名）患者表示他们没有被征询意见（即没有共同决策）。在其他 111 名患者中，49 名患者的实际参与度与他们期望的完全一致，37 名患者的参与度低于他们期望的水平，23 名患者的责任超过了他们期望的水平。Kappa 统计显示，期望角色和实际角色之间存在中等一致性（κw=0.57；95%CI：0.45-0.69）。大多数患者希望在不必询问的情况下获得更多信息。年龄、性别或教育程度与期望角色之间没有相关性。35%的患者同意他们经历了一些他们被问到的决策障碍：1）疾病的严重程度，2）医生的不同治疗策略，3）理解医疗信息的困难，4）理解不讲患者自己语言的医生的困难。
医生在沟通程度或患者参与决策方面并没有完全满足患者的偏好。参与障碍可能是一个问题，在处理住院老年人时应更加重视。
