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如果在会诊中经历了决策冲突,更多的初级保健患者会对健康决策感到后悔:一项多中心描述性研究的二次分析。

More primary care patients regret health decisions if they experienced decisional conflict in the consultation: a secondary analysis of a multicenter descriptive study.

作者信息

Becerra-Perez Maria-Margarita, Menear Matthew, Turcotte Stephane, Labrecque Michel, Légaré France

机构信息

CHU de Québec Research Centre -Laval University, St-François d'Assise Hospital, 10 de l'Espinay, Quebec City, QC, G1L 3L5, Canada.

Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue Ferdinard-Vandry, Quebec City, QC, G1V 0A6, Canada.

出版信息

BMC Fam Pract. 2016 Nov 10;17(1):156. doi: 10.1186/s12875-016-0558-0.

Abstract

BACKGROUND

We sought to estimate the extent of decision regret among primary care patients and identify risk factors associated with regret.

METHODS

Secondary analysis of an observational descriptive study conducted in two Canadian provinces. Unique patient-physician dyads were recruited from 17 primary care clinics and data on patient, physician and consultation characteristics were collected before, during and immediately after consultations, as well as two weeks post-consultation, when patients completed the Decision Regret Scale (DRS). We examined the DRS score distribution and performed ordinal logistic regression analysis to identify predictors of regret.

RESULTS

Among 258 unique patient-physicians dyads, mean ± standard deviation of decision regret scores was 11.7 ± 15.1 out of 100. Overall, 43 % of patients reported no regret, 45 % reported mild regret and 12 % reported moderate to strong regret. In multivariate analyses, higher decision regret was strongly associated with increased decisional conflict and less significantly associated with patient age and education, as well with male (vs. female) physicians and residents (vs. teachers).

CONCLUSION

After consulting family physicians, most primary care patients experience little decision regret, but some experience more regret if there is decisional conflict. Strategies for reducing decisional conflict in primary care, such as shared decision-making with decision aids, seem warranted.

摘要

背景

我们试图评估初级保健患者中决策后悔的程度,并确定与后悔相关的风险因素。

方法

对在加拿大两个省份进行的一项观察性描述性研究进行二次分析。从17家初级保健诊所招募了独特的患者-医生二元组,并在会诊前、会诊期间、会诊后立即以及会诊后两周(此时患者完成决策后悔量表(DRS))收集有关患者、医生和会诊特征的数据。我们检查了DRS评分分布,并进行了有序逻辑回归分析以确定后悔的预测因素。

结果

在258个独特的患者-医生二元组中,决策后悔评分的平均值±标准差为11.7±15.1(满分100分)。总体而言,43%的患者表示无悔,45%的患者表示轻度后悔,12%的患者表示中度至强烈后悔。在多变量分析中,较高的决策后悔与决策冲突增加密切相关,与患者年龄和教育程度、男性(与女性)医生以及住院医生(与教师)的关联则不太显著。

结论

在咨询家庭医生后,大多数初级保健患者几乎没有决策后悔,但如果存在决策冲突,一些患者会有更多后悔。在初级保健中减少决策冲突的策略,如使用决策辅助工具进行共同决策,似乎是有必要的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f95/5103443/2d9566c974c6/12875_2016_558_Fig1_HTML.jpg

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