CHU de Québec - Université Laval Research Centre, Québec City, Québec, Canada.
CHU de Québec - Université Laval Research Centre, Québec City, Québec, Canada Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Laval University, Québec City, Québec, Canada.
BMJ Open. 2016 Jun 28;6(6):e011490. doi: 10.1136/bmjopen-2016-011490.
Unresolved clinically significant decisional conflict (CSDC) in patients following a consultation with health professionals is often the result of inadequate patient involvement in decision-making and may result in poor outcomes. We sought to identify the prevalence of CSDC in studies on decision-making in primary care and to explore its risk factors.
We performed a secondary analysis of existing data sets from studies conducted in Primary Care Practice-Based Research Networks in Québec and Ontario, Canada.
Eligible studies included a patient-reported measure on the 16-item Decisional Conflict Scale (DCS) following a decision made with a healthcare professional with no study design restriction.
CSDC was defined as a score ≥25/100 on the DCS. The prevalence of CSDC was stratified by sex; and patient-level logistic regression analysis was performed to explore its potential risk factors. Data sets of studies were analysed individually and qualitatively compared.
5 projects conducted between 2003 and 2010 were included. They covered a range of decisions: prenatal genetic screening, antibiotics for acute respiratory infections and miscellaneous. Altogether, the 5 projects gathered data from encounters with a total of 1338 primary care patients (69% female; range of age 15-83). The prevalence of CSDC in patients varied across studies and ranged from 10.3% (95% CI 7.2% to 13.4%) to 31.1% (95% CI 26.6% to 35.6%). Across the 5 studies, risk factors of CSDC included being male, living alone and being 45 or older.
Prevalence of CSDC in patients who had enrolled in studies conducted in primary care contexts was substantial and appeared to vary according to the type of decision as well as to patient characteristics such as sex, living arrangement and age. Patients presenting risk factors of CSDC should be offered tools to increase their involvement in decision-making.
在与卫生专业人员咨询后，患者仍存在未解决的具有临床意义的决策冲突（CSDC），通常是由于患者参与决策不足造成的，这可能导致不良结果。我们试图确定在初级保健决策研究中 CSDC 的发生率，并探讨其危险因素。
我们对加拿大魁北克和安大略省的初级保健实践基础研究网络进行的现有数据集进行了二次分析。
符合条件的研究包括在与医疗保健专业人员做出决策后，使用 16 项决策冲突量表（DCS）对患者进行的患者报告测量，且无研究设计限制。
CSDC 的定义为 DCS 评分≥25/100。根据性别对 CSDC 的发生率进行分层，并对其潜在危险因素进行患者水平的逻辑回归分析。单独分析数据集，并进行定性比较。
纳入了 2003 年至 2010 年期间进行的 5 项研究。它们涵盖了一系列决策：产前基因筛查、急性呼吸道感染和杂项抗生素。这 5 个项目共收集了来自 1338 名初级保健患者的就诊数据（69%为女性；年龄 15-83 岁）。不同研究中患者 CSDC 的发生率存在差异，范围为 10.3%（95%CI 7.2%-13.4%）至 31.1%（95%CI 26.6%-35.6%）。在这 5 项研究中，CSDC 的危险因素包括男性、独居和 45 岁或以上。
在参与初级保健环境中进行的研究的患者中，CSDC 的发生率相当高，而且似乎因决策类型以及患者特征（如性别、居住安排和年龄）而异。具有 CSDC 危险因素的患者应提供工具来增加其参与决策的程度。
