Gong Hyun Sik, Park Jin Woo, Shin Young Ho, Kim Kahyun, Cho Kwan Jae, Baek Goo Hyun
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
BMC Musculoskelet Disord. 2017 Mar 21;18(1):118. doi: 10.1186/s12891-017-1478-4.
Although a model for shared decision-making is important for patient-centered care, decisional conflict can emerge when patients participate in the decision-making. A decision aid is proposed to provide information and to involve patients more comfortably in the decision-making process. We aimed to determine whether a decision aid helps patients with carpal tunnel syndrome (CTS) experience less decisional conflict regarding their decision-making for surgery.
Eighty patients with CTS were randomized into two groups. The test group was given a decision aid in addition to regular information and the control group regular information only. The decision aid consisted of a 6-min videoclip that explains diagnosis and information regarding surgery for CTS with other treatment options. We evaluated patients' decisional conflict regarding surgery, knowledge about CTS, and symptom severity as measured by the Disabilities of Arm, Shoulder, and Hand (DASH) Questionnaire.
There was no difference in the decisional conflict scale (DCS) between both groups (p = 0.76). The test group had significantly better knowledge than the control group (p = 0.04). There was no correlation between the knowledge score and the DCS (p = 0.76). However, less severe symptoms were correlated with greater decisional conflict (r = -0.29, p = 0.02).
We found that a decision aid does not reduce decisional conflict in patients with CTS, although it can help them be better informed. This study suggests that although a decision-aid is effective for patient education, doctor-patient communication should be more emphasized for patients with less severe symptoms, as they can have greater decisional conflict.
SNUBH Registry 1510/317-003 Registered November 13, 2015.
虽然共同决策模式对以患者为中心的医疗至关重要，但患者参与决策时可能会出现决策冲突。有人提出使用决策辅助工具来提供信息，并让患者更轻松地参与决策过程。我们旨在确定决策辅助工具是否有助于腕管综合征（CTS）患者在手术决策中减少决策冲突。
80例CTS患者被随机分为两组。试验组除接受常规信息外，还给予决策辅助工具，而对照组仅接受常规信息。决策辅助工具包括一个6分钟的视频片段，解释CTS的诊断、手术信息以及其他治疗选择。我们评估了患者在手术方面的决策冲突、对CTS的了解程度以及通过手臂、肩部和手部功能障碍（DASH）问卷测量的症状严重程度。
两组之间的决策冲突量表（DCS）没有差异（p = 0.76）。试验组的知识掌握情况明显优于对照组（p = 0.04）。知识得分与DCS之间没有相关性（p = 0.76）。然而，症状较轻与更大的决策冲突相关（r = -0.29，p = 0.02）。
我们发现决策辅助工具并不能减少CTS患者的决策冲突，尽管它可以帮助他们更好地了解情况。这项研究表明，虽然决策辅助工具对患者教育有效，但对于症状较轻的患者，应更加强调医患沟通，因为他们可能有更大的决策冲突。
SNUBH注册中心1510/317 - 003，于2015年11月13日注册。
