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[肿瘤学中实施共同决策的障碍与促进因素:患者认知]

[Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions].

作者信息

Ortega-Moreno M, Padilla-Garrido N, Huelva-López L, Aguado-Correa F, Bayo-Calero J, Bayo-Lozano E

机构信息

Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España.

Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España.

出版信息

Rev Calid Asist. 2017 May-Jun;32(3):141-145. doi: 10.1016/j.cali.2017.01.002. Epub 2017 Mar 6.

Abstract

OBJECTIVE

To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented.

MATERIAL AND METHODS

A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators.

RESULTS

More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors.

CONCLUSIONS

The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient.

摘要

目的

从肿瘤患者的角度确定是谁做出了关于其治疗的决定,以及促成实施共同决策的主要障碍和促进因素。

材料与方法

采用自填式问卷对选定的癌症患者进行横断面、描述性和相关性研究,在不同肿瘤诊所进行随机抽样并在不同时间段进行。共有108名患者提供了可分析的数据。收集了关于社会人口统计学和临床变量、谁做出治疗决定以及对各种障碍和促进因素的同意或不同意程度的信息。

结果

超过三分之一(38.1%)的患者声称与医生参与了共同决策。时间、理解困难、家长作风、缺乏流畅沟通以及拥有初步且往往错误的信息等障碍影响了参与决策。然而,是否拥有足够的辅助决策工具或患者参与的兴趣并无影响。至于促进因素,医生的积极性、他们对改善的认知以及患者的兴趣有积极影响。对医生的经济激励可能性除外。

结论

癌症患者在其健康决策中参与度低或无参与,这使得有必要改进医疗保健模式以克服障碍并促进患者更积极的参与态度。

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