Alden Dana L
University of Hawai'i at Manoa, Honolulu, HI, USA (DLA)
Med Decis Making. 2014 Oct;34(7):884-98. doi: 10.1177/0272989X14536780. Epub 2014 Jun 5.
Despite progress, models that incorporate antecedent and mediating factors associated with shared decision making (SDM)-related outcomes remain limited. An experimental study tests patient decision aid (DA) effects on a network of antecedents and mediators associated with patient empowerment prior to a medical decision-making consultation regarding cancer treatment.
A pilot study initially evaluated measurement scales, model fit, and the overall effect of the DA experience. The pilot compared matched treatment and control group samples of US adult online panel members exposed to a vignette about meeting their dermatologist to decide on skin cancer treatment. The treatment group also experienced a skin cancer DA with treatment options and value clarification activity, while the control group did not. The main study employed a randomized experimental design to formally test hypothesized path coefficients across the groups.
The pilot study suggested an overall enhanced DA effect on self-empowerment. In the experimental study, the DA experience strengthened the direct path from desire for medical information to self-empowerment and the indirect path from comprehension/participation confidence to self-empowerment through cancer attitude. The DA had no strengthening effect on the direct path from life satisfaction to self-empowerment, but in the DA condition, the factor appeared to play a role by contributing to the enhanced association between confidence and cancer attitude.
Evidence from this research indicates that experiencing a DA prior to treatment decision making affects patient empowerment through a network that includes desire for information, life satisfaction, and multiple mediators. The studies also demonstrate the role that theory-based, multigroup structural equation modeling (SEM) can play in increasing understanding of DA effects. Such understanding is critical to improving SDM between patients and their physicians.
尽管取得了进展，但纳入与共同决策（SDM）相关结果的先行因素和中介因素的模型仍然有限。一项实验研究测试了患者决策辅助工具（DA）在癌症治疗医疗决策咨询之前，对与患者赋权相关的先行因素和中介因素网络的影响。
一项试点研究最初评估了测量量表、模型拟合以及DA体验的总体效果。该试点比较了美国成年在线小组成员中匹配的治疗组和对照组样本，这些成员接触了一个关于与皮肤科医生会面以决定皮肤癌治疗的案例。治疗组还体验了一个包含治疗选择和价值澄清活动的皮肤癌DA，而对照组没有。主要研究采用随机实验设计，正式测试各小组之间假设的路径系数。
试点研究表明DA对自我赋权有总体增强作用。在实验研究中，DA体验加强了从对医疗信息的渴望到自我赋权的直接路径，以及从理解/参与信心通过癌症态度到自我赋权的间接路径。DA对从生活满意度到自我赋权的直接路径没有增强作用，但在DA条件下，该因素似乎通过促进信心与癌症态度之间增强的关联而发挥作用。
这项研究的证据表明，在治疗决策之前体验DA会通过一个包括对信息的渴望、生活满意度和多个中介因素的网络影响患者赋权。这些研究还证明了基于理论的多组结构方程建模（SEM）在增进对DA效果理解方面可以发挥的作用。这种理解对于改善患者与其医生之间的SDM至关重要。
