Warner David O, LeBlanc Annie, Kadimpati Sandeep, Vickers Kristin S, Shi Yu, Montori Victor M
From the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota (D.O.W., S.K., Y.S.); Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, Minnesota (A.L.); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (K.S.V.); and Knowledge and Evaluation Research Unit, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (V.M.M.).
Anesthesiology. 2015 Jul;123(1):18-28. doi: 10.1097/ALN.0000000000000704.
Decision aids can increase patient involvement in decision-making about health care. The study goal was to develop and test a decision aid for use by clinicians in discussion options for changing smoking behavior before and after elective surgery.
In formative work, a decision aid was designed to facilitate patient-clinician discussion regarding three options: continue smoking, attempt a period of temporary abstinence, and attempt to quit smoking for good. A randomized, two-group pilot study was then conducted in smokers evaluated in preparation for elective surgery in a preoperative clinic to test the hypothesis that the decision aid would improve measures of decisional quality compared with usual care.
The final decision aid consisted of three laminated cards. The front of each card included a colorful graphic describing each choice; the reverse including two to three pros and cons for each decision, a simple graphic illustrating the effects of smoking on the body, and a motivational phrase. In the randomized trial of 130 patients, the decision aid significantly (P < 0.05) improved measures of decisional quality and patient involvement in decision making (Cohen's d effect sizes of 0.76 and 1.20 for the Decisional Conflict Scale and Observing PatienT involvement In decisiON-making scale, respectively). However, the decision aid did not affect any aspect of perioperative smoking behavior, including the distribution of or adherence to choices.
Although the use of a decision aid to facilitate clinician-patient discussions regarding tobacco use around the time of surgery substantially improved measures of decisional quality, it alone did not change perioperative tobacco use behavior.
决策辅助工具可增加患者在医疗保健决策中的参与度。本研究的目标是开发并测试一种决策辅助工具，供临床医生在择期手术前后讨论改变吸烟行为的选项时使用。
在前期形成性工作中，设计了一种决策辅助工具，以促进医患就三种选择进行讨论：继续吸烟、尝试一段时间的临时戒烟、尝试永久戒烟。然后，在一家术前诊所对准备接受择期手术的吸烟者进行了一项随机两组试点研究，以检验这一假设：与常规护理相比，该决策辅助工具能改善决策质量指标。
最终的决策辅助工具由三张层压卡片组成。每张卡片正面都有一个彩色图表描述每种选择；反面包括每个决策的两到三个优缺点、一个说明吸烟对身体影响的简单图表以及一条激励性语句。在对130名患者进行的随机试验中，该决策辅助工具显著（P<0.05）改善了决策质量指标以及患者在决策中的参与度（决策冲突量表和观察患者决策参与量表的科恩d效应量分别为0.76和1.20）。然而，该决策辅助工具并未影响围手术期吸烟行为的任何方面，包括选择的分布或依从性。
虽然使用决策辅助工具来促进手术前后医患关于烟草使用的讨论能显著改善决策质量指标，但仅凭它并不能改变围手术期的烟草使用行为。
