Mathews Alexandra L, Coleska Adriana, Burns Patricia B, Chung Kevin C
University of Michigan, Ann Arbor.
Arthritis Care Res (Hoboken). 2016 Mar;68(3):318-24. doi: 10.1002/acr.22688.
The migration of health care toward a consumer-driven system favors increased patient participation during the treatment decision-making process. Patient involvement in treatment decision discussions has been linked to increased treatment adherence and patient satisfaction. Previous studies have quantified decision-making styles of patients with rheumatoid arthritis (RA); however, none of them have considered the evolution of patient involvement after living with RA for many years. We conducted a qualitative study to determine the decision-making model used by long-term RA patients, and to describe the changes in their involvement over time.
Twenty participants were recruited from the ongoing Silicone Arthroplasty in Rheumatoid Arthritis study. Semistructured interviews were conducted and data were analyzed using grounded theory methodology.
Nineteen out of 20 participants recalled using the paternalistic decision-making (PDM) model immediately following their diagnosis. Fourteen of the 19 participants who initially used PDM evolved to shared decision-making (SDM). Participants attributed the change in involvement to the development of a trusting relationship with their physician, as well as to becoming educated about the disease.
When initially diagnosed with RA, patients may let their physician decide on the best treatment course. However, over time patients may evolve to exercise a more collaborative role. Physicians should understand that even within SDM, each patient can demonstrate a varied amount of autonomy. It is up to the physician to have a discussion with each patient to determine his or her desired level of involvement.
医疗保健向消费者驱动型系统的转变有利于在治疗决策过程中增加患者的参与度。患者参与治疗决策讨论与提高治疗依从性和患者满意度有关。先前的研究已经对类风湿关节炎（RA）患者的决策风格进行了量化；然而，这些研究都没有考虑RA患者多年患病后的参与度变化情况。我们进行了一项定性研究，以确定长期RA患者所采用的决策模型，并描述他们随时间推移参与度的变化。
从正在进行的类风湿关节炎硅胶关节成形术研究中招募了20名参与者。进行了半结构化访谈，并使用扎根理论方法对数据进行了分析。
20名参与者中有19人回忆起在确诊后立即采用家长式决策（PDM）模型。最初采用PDM的19名参与者中有14人转变为共同决策（SDM）。参与者将参与度的变化归因于与医生建立了信任关系，以及对疾病有了更多了解。
最初被诊断为RA时，患者可能会让医生决定最佳治疗方案。然而，随着时间的推移，患者可能会逐渐发挥更具协作性的作用。医生应该明白，即使在SDM模式下，每个患者表现出的自主程度也可能不同。医生有责任与每位患者进行讨论，以确定其期望的参与程度。
