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让患者参与多学科指南制定第一步的附加价值:一项针对不孕患者的定性访谈研究

Added value of involving patients in the first step of multidisciplinary guideline development: a qualitative interview study among infertile patients.

作者信息

den Breejen Elvira M E, Hermens Rosella P M G, Galama Wienke H, Willemsen Wim N P, Kremer Jan A M, Nelen Willianne L D M

机构信息

Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Internal Postal Code 791, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

IQ healthcare, Radboud University Medical Centre Nijmegen, Internal Postal Code 114, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

出版信息

Int J Qual Health Care. 2016 Jun;28(3):299-305. doi: 10.1093/intqhc/mzw020. Epub 2016 Mar 10.

Abstract

BACKGROUND

Patient involvement in scoping the guideline is emphasized, but published initiatives actively involving patients are generally limited to the writing and reviewing phase.

OBJECTIVE

To assess patients' added value to the scoping phase of a multidisciplinary guideline on infertility.

DESIGN

Qualitative interview study.

SETTING AND PARTICIPANTS

We conducted interviews among 12 infertile couples and 17 professionals.

INTERVENTION

We listed and compared the couples' and professionals' key clinical issues (=care aspects that need improvement) to be addressed in the guideline according to four domains: current guidelines, professionals, patients and organization of care.

MAIN OUTCOME MEASURES

Main key clinical issues suggested by more than three quarters of the infertile couples and/or at least two professionals were identified and compared.

RESULTS

Overall, we identified 32 key clinical issues among infertile couples and 23 among professionals. Of the defined main key clinical issues, infertile couples mentioned eight issues that were not mentioned by the professionals. These main key clinical issues mainly concerned patient-centred (e.g. poor information provision and poor alignment of care) aspects of care on the professional and organizational domain. Both groups mentioned two main key clinical issues collectively that were interpreted differently: the lack of emotional support and respect for patients' values.

CONCLUSIONS

Including patients from the first phase of the guideline development process leads to valuable additional main key clinical issues for the next step of a multidisciplinary guideline development process and broadens the scope of the guideline, particularly regarding patient-centredness and organizational issues from a patients' perspective.

摘要

背景

虽然强调患者参与指南范围界定,但已发表的积极让患者参与的举措通常仅限于编写和评审阶段。

目的

评估患者对不育症多学科指南范围界定阶段的附加价值。

设计

定性访谈研究。

地点和参与者

我们对12对不育夫妇和17名专业人员进行了访谈。

干预措施

我们列出并比较了夫妇和专业人员在指南中要解决的关键临床问题(即需要改进的护理方面),这些问题根据四个领域划分:现行指南、专业人员、患者和护理组织。

主要结局指标

确定并比较了超过四分之三的不育夫妇和/或至少两名专业人员提出的主要关键临床问题。

结果

总体而言,我们在不育夫妇中确定了32个关键临床问题,在专业人员中确定了23个。在确定的主要关键临床问题中,不育夫妇提到了8个专业人员未提及的问题。这些主要关键临床问题主要涉及专业和组织领域中以患者为中心的护理方面(如信息提供不足和护理协调不佳)。两组共同提到了两个主要关键临床问题,但理解不同:缺乏情感支持和对患者价值观的尊重。

结论

在指南制定过程的第一阶段纳入患者,会为多学科指南制定过程的下一步带来有价值的额外主要关键临床问题,并拓宽指南的范围,特别是从患者角度看以患者为中心和组织问题方面。

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