Robinski Maxi, Mau Wilfried, Wienke Andreas, Girndt Matthias
Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Patient Educ Couns. 2016 Apr;99(4):562-570. doi: 10.1016/j.pec.2015.10.014. Epub 2015 Oct 29.
To compare differences in shared decision-making (SDM) and treatment satisfaction (TS) between haemodialysis (HD) and peritoneal dialysis (PD) patients.
6-24 months after initiation of dialysis, we surveyed 780 patients from throughout Germany (CORETH-project) regarding SDM, the reason for modality choice and TS. Data were compared between two age-, comorbidity-, education-, and employment status-matched groups (n=482).
PD patients rated all aspects of SDM more positively than did HD patients (total score: MPD=84.6, SD=24.1 vs. MHD=61.9, SD=37.3; p≤0.0001). The highest difference occurred for the item "announcement of a necessary decision" (delta=1.3 points on a 6-point Likert-scale). PD patients indicated their desire for independence as a motivator for choosing PD (65%), whereas HD patients were subject to medical decisions (23%) or wanted to rely on medical support (20%). We found positive correlations between SDM and TS (0.16≤r≤0.48; p≤0.0001).
Our findings increase awareness of a participatory nephrological counseling-culture and imply that SDM can pave the way for quality of life and treatment success for dialysis patients.
Practitioners can facilitate SDM by screening patient preferences at an early stage, being aware of biases in consultation, using easy terminology and encouraging passive patients to participate in the choice.
比较血液透析（HD）患者和腹膜透析（PD）患者在共同决策（SDM）和治疗满意度（TS）方面的差异。
在开始透析6 - 24个月后，我们对来自德国各地的780名患者（CORETH项目）进行了关于共同决策、透析方式选择原因和治疗满意度的调查。在两个年龄、合并症、教育程度和就业状况匹配的组（n = 482）之间对数据进行了比较。
PD患者对共同决策的各个方面的评价均比HD患者更积极（总分：MPD = 84.6，SD = 24.1 vs. MHD = 61.9，SD = 37.3；p≤0.0001）。在“必要决策的告知”这一项目上差异最大（在6点李克特量表上相差1.3分）。PD患者表示他们希望独立是选择PD的一个动机（65%），而HD患者则听从医疗决策（23%）或希望依靠医疗支持（20%）。我们发现共同决策与治疗满意度之间存在正相关（0.16≤r≤0.48；p≤0.0001）。
我们的研究结果提高了对参与性肾脏咨询文化的认识，并表明共同决策可以为透析患者的生活质量和治疗成功铺平道路。
从业者可以通过在早期筛查患者偏好、意识到咨询中的偏差、使用简单术语以及鼓励消极的患者参与选择来促进共同决策。
