Hofstede Stefanie N, van Bodegom-Vos Leti, Wentink Manon M, Vleggeert-Lankamp Carmen L A, Vliet Vlieland Thea P M, Marang-van de Mheen Perla J
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
PLoS One. 2014 Apr 7;9(4):e94176. doi: 10.1371/journal.pone.0094176. eCollection 2014.
Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is not known how SDM should be integrated in multidisciplinary practice. This study determines the most important factors for SDM implementation in sciatica care, as it is known that a prior inventory of factors is crucial to develop a successful implementation strategy.
246 professionals (general practitioners, physical therapists, neurologists, neurosurgeons, orthopedic surgeons) (30% response) and 155 patients (96% response) responded to an internet-based survey. Respondents ranked barriers and facilitators identified in previous interviews, on their importance using Maximum Difference Scaling. Feeding back the personal top 5 most important factors, each respondent indicated whether these factors were barriers or facilitators. Hierarchical Bayes estimation was used to estimate the relative importance (RI) of each factor.
Professionals assigned the highest importance to: quality of professional-patient relationship (RI 4.87; CI 4.75-4.99); importance of quick recovery of patient (RI 4.83; CI 4.69-4.97); and knowledge about treatment options (RI 6.64; CI 4.53-4.74), which were reported as barrier and facilitator. Professionals working in primary care had a different ranking than those working in hospital care. Patients assigned the highest importance to: correct diagnosis by professionals (barrier, RI 8.19; CI 7.99-8.38); information provision about treatment options and potential harm and benefits (RI 7.87; CI 7.65-8.08); and explanation of the professional about the care trajectory (RI 7.16; CI 6.94-7.38), which were reported as barrier and facilitator.
Knowledge, information provision and a good relationship are the most important conditions for SDM perceived by both patients and professionals. These conditions are not restricted to one specific disease or health care system, because they are mostly professional or patient dependent and require healthcare professional training.
由于医学专业人员的专业化程度不断提高，患者由多个学科进行治疗。为确保所提供的护理以患者为中心，专业人员与患者共同决定治疗方案（共同决策，SDM）至关重要。然而，尚不清楚如何将共同决策融入多学科实践中。本研究确定了坐骨神经痛护理中实施共同决策的最重要因素，因为众所周知，事先梳理这些因素对于制定成功的实施策略至关重要。
246名专业人员（全科医生、物理治疗师、神经科医生、神经外科医生、骨科医生）（回复率30%）和155名患者（回复率96%）对一项基于互联网的调查做出了回应。受访者使用最大差异量表对先前访谈中确定的障碍和促进因素的重要性进行了排序。在反馈个人最重要的5个因素时，每位受访者指出这些因素是障碍还是促进因素。采用分层贝叶斯估计来估计每个因素的相对重要性（RI）。
专业人员认为最重要的因素是：医患关系质量（RI 4.87；CI 4.75 - 4.99）；患者快速康复的重要性（RI 4.83；CI 4.69 - 4.97）；以及对治疗选择的了解（RI 6.64；CI 4.53 - 4.74），这些因素既有障碍因素也有促进因素。初级保健领域的专业人员与医院护理领域的专业人员排名不同。患者认为最重要的因素是：专业人员的正确诊断（障碍，RI 8.19；CI 7.99 - 8.38）；关于治疗选择以及潜在危害和益处的信息提供（RI 7.87；CI 7.65 - 8.08）；以及专业人员对护理过程的解释（RI 7.16；CI 6.94 - 7.38），这些因素既有障碍因素也有促进因素。
知识、信息提供和良好的关系是患者和专业人员都认为的共同决策最重要的条件。这些条件并不局限于一种特定疾病或医疗保健系统，因为它们大多取决于专业人员或患者，并且需要对医疗保健专业人员进行培训。
