Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC USA.
BMC Med Inform Decis Mak. 2014 Feb 28;14:14. doi: 10.1186/1472-6947-14-14.
Decision aids offer promise as a practical solution to improve patient decision making about coronary heart disease (CHD) prevention medications and help patients choose medications to which they are likely to adhere. However, little data is available on decision aids designed to promote adherence.
In this paper, we report on secondary analyses of a randomized trial of a CHD adherence intervention (second generation decision aid plus tailored messages) versus usual care in an effort to understand how the decision aid facilitates adherence. We focus on data collected from the primary study visit, when intervention participants presented 45 minutes early to a previously scheduled provider visit; viewed the decision aid, indicating their intent for CHD risk reduction after each decision aid component (individualized risk assessment and education, values clarification, and coaching); and filled out a post-decision aid survey assessing their knowledge, perceived risk, decisional conflict, and intent for CHD risk reduction. Control participants did not present early and received usual care from their provider. Following the provider visit, participants in both groups completed post-visit surveys assessing the number and quality of CHD discussions with their provider, their intent for CHD risk reduction, and their feelings about the decision aid.
We enrolled 160 patients into our study (81 intervention, 79 control). Within the decision aid group, the decision aid significantly increased knowledge of effective CHD prevention strategies (+21 percentage points; adjusted p<.0001) and the accuracy of perceived CHD risk (+33 percentage points; adjusted p<.0001), and significantly decreased decisional conflict (-0.63; adjusted p<.0001). Comparing between study groups, the decision aid also significantly increased CHD prevention discussions with providers (+31 percentage points; adjusted p<.0001) and improved perceptions of some features of patient-provider interactions. Further, it increased participants' intentions for any effective CHD risk reducing strategies (+21 percentage points; 95% CI 5 to 37 percentage points), with a majority of the effect from the educational component of the decision aid. Ninety-nine percent of participants found the decision aid easy to understand and 93% felt it easy to use.
Decision aids can play an important role in improving decisions about CHD prevention and increasing patient-provider discussions and intent to reduce CHD risk.
决策辅助工具作为一种实用的解决方案，可以改善患者在冠心病（CHD）预防药物方面的决策，并帮助患者选择他们可能会坚持使用的药物。然而，关于旨在促进依从性的决策辅助工具的数据很少。
在本文中，我们报告了一项冠心病依从性干预（第二代决策辅助工具加定制信息）与常规护理的随机试验的二次分析，以努力了解决策辅助工具如何促进依从性。我们专注于从主要研究访问收集的数据，当时干预参与者提前 45 分钟出现在之前预定的提供者访问中；查看决策辅助工具，并在每个决策辅助工具组件（个性化风险评估和教育、价值观澄清和辅导）后表示他们降低 CHD 风险的意图；并填写决策辅助工具后调查，评估他们的知识、感知风险、决策冲突和降低 CHD 风险的意图。对照组没有提前出现，而是从他们的提供者那里接受常规护理。在就诊结束后，两组参与者都完成了关于与提供者讨论 CHD 的次数和质量、他们降低 CHD 风险的意图以及对决策辅助工具的感受的就诊后调查。
我们的研究共纳入 160 名患者（81 名干预组，79 名对照组）。在决策辅助组中，决策辅助工具显著增加了对有效 CHD 预防策略的了解（增加 21 个百分点；调整后 p<.0001）和对感知 CHD 风险的准确性（增加 33 个百分点；调整后 p<.0001），并显著降低了决策冲突（-0.63；调整后 p<.0001）。在研究组之间进行比较时，决策辅助工具还显著增加了与提供者的 CHD 预防讨论（增加 31 个百分点；调整后 p<.0001），并改善了患者与提供者互动的一些特征的认知。此外，它增加了参与者对任何有效 CHD 风险降低策略的意图（增加 21 个百分点；95%CI 5 至 37 个百分点），其中大部分效果来自决策辅助工具的教育部分。99%的参与者认为决策辅助工具易于理解，93%的参与者认为它易于使用。
决策辅助工具可以在改善冠心病预防决策、增加患者与提供者的讨论以及降低冠心病风险的意图方面发挥重要作用。
