Kuhnigk Olaf, Slawik Lara, Meyer Jelka, Naber Dieter, Reimer Jens
University Medical Centre Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
J Psychiatr Pract. 2012 Sep;18(5):321-8. doi: 10.1097/01.pra.0000419816.75752.65.
This study investigated and compared the valuation and perceived attainment of multiple treatment goals in schizophrenia from the perspectives of four different groups of stakeholders.
Twenty treatment goals (identified in a qualitative patient-based pre-study) were ranked and rated according to their relevance in standardized interviews. Goal attainment was also rated. A rank correlation was computed to identify congruencies among the stakeholder groups. A hierarchical cluster analysis of the data from the stakeholders groups was also conducted.
In this study, 105 outpatients, 160 physicians, 50 relatives, and 30 payers were interviewed. All goals were considered very relevant by all stakeholder groups. "Improved cognitive abilities" was ranked among the top three goals by patients, physicians, and relatives, while "reduced disease-related symptoms" was ranked first by relatives and second by physicians. Payers gave the highest priority to goals that were more likely to affect costs (i.e., ability to resume work, reduced disease-related symptoms, less hospitalization/ need for outpatient visits). Pairwise agreement rates ranged from 38.9% to 63.3%. Rank correlations were found between relatives and patients (r=0.51; P=0.002), relatives and physicians (r=0.43; P=0.008), and payers and patients (r=0.43; P=0.008). The cluster analysis revealed a relevant congruency among patients, relatives, and physicians. Goal attainment was rated lower than goal relevance by all groups, with patients judging attainment the best on average, followed by relatives, physicians, and payers. Reduction in disease-related symptoms was rated as the goal that was best achieved.
Discordances among the groups with respect to their valuation of treatment goals should encourage stakeholders to better understand others' preferences as a prerequisite for improved shared decision making and potentially improved treatment outcomes.
本研究从四类不同利益相关者的角度，调查并比较了精神分裂症多种治疗目标的重要性评估及目标达成情况。
根据一项基于患者的定性预研究确定的20个治疗目标，在标准化访谈中按照其相关性进行排序和评分。同时对目标达成情况进行评分。计算等级相关性以确定利益相关者群体之间的一致性。还对利益相关者群体的数据进行了层次聚类分析。
本研究共访谈了105名门诊患者、160名医生、50名亲属和30名支付方。所有利益相关者群体都认为所有目标都非常重要。“认知能力改善”在患者、医生和亲属列出的目标中位列前三，而“疾病相关症状减轻”在亲属列出的目标中排第一，在医生列出的目标中排第二。支付方最优先考虑的目标是那些更可能影响成本的目标（即恢复工作的能力、疾病相关症状减轻、住院次数减少/门诊就诊需求减少）。两两一致性率在38.9%至63.3%之间。亲属与患者之间（r = 0.51；P = 0.002）、亲属与医生之间（r = 0.43；P = 0.008）以及支付方与患者之间（r = 0.43；P = 0.008）均发现了等级相关性。聚类分析显示患者、亲属和医生之间存在显著的一致性。所有群体对目标达成情况的评分均低于目标重要性评分，其中患者对目标达成情况的评价平均最佳，其次是亲属、医生和支付方。疾病相关症状的减轻被评为达成情况最好的目标。
各群体在治疗目标重要性评估方面存在差异，这应促使利益相关者更好地理解他人的偏好，以此作为改善共同决策并可能改善治疗效果的前提条件。
