Krist Alex H, Woolf Steven H, Hochheimer Camille, Sabo Roy T, Kashiri Paulette, Jones Resa M, Lafata Jennifer Elston, Etz Rebecca S, Tu Shin-Ping
Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia.
Ann Fam Med. 2017 May;15(3):217-224. doi: 10.1370/afm.2063.
Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases.
Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey.
In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%).
Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated.
技术可通过预测患者的信息需求、评估患者在决策和偏好方面的进展情况、个性化教育体验、促进患者与临床医生之间的信息交流以及支持后续跟进，来改变常规决策过程。本研究以3项癌症筛查决策作为测试案例，评估患者和临床医生是否会使用这样的决策模块及其对医疗护理的影响。
12家使用患者门户网站且拥有55453名患者的医疗机构参与了这项前瞻性观察队列研究。研究对象为可能面临癌症筛查决策的患者：年龄在40至49岁且两年内未进行乳房X光检查的女性、年龄在55至69岁且两年内未进行前列腺特异性抗原检测的男性，以及年龄在50至74岁且 overdue for 结直肠癌筛查的成年人。数据来源包括模块回复、电子健康记录数据和就诊后调查。
在1年时间里，五分之一的门户网站用户（11458名患者）面临潜在的癌症筛查决策。在这些患者中，20.6%开始使用决策模块，7.9%完成了该模块。完成模块的患者中有47.2%与他们的临床医生分享了回复。在他们下次就诊后，57.8% 的受访者认为他们的临床医生已经看过他们的回复，许多人表示该模块使他们的就诊更有成效（40.7%），有助于他们参与决策（47.7%），拓宽了他们的知识（48.1%），并改善了沟通（37.5%）。
许多患者面临的决策可以通过技术进行预测和主动推动。尽管技术的使用有可能使就诊更加高效，但在其能够广泛传播之前，还需要进行文化、工作流程和技术方面的变革。
