决策辅助工具中患者偏好测量是否能改善决策冲突？一项针对前列腺癌男性的随机试验。
Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.
机构信息
UCLA Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Los Angeles, CA, 90095, USA.
Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
出版信息
Patient. 2017 Dec;10(6):785-798. doi: 10.1007/s40271-017-0255-7.
BACKGROUND
Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement.
OBJECTIVES
We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting.
METHODS
Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation.
RESULTS
Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups.
CONCLUSIONS
Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.
背景
共享决策（SDM）已被提倡为一种改善决策质量的医疗决策方法。决策辅助工具是在医生时间有限的情况下促进 SDM 的工具；然而，许多决策辅助工具并未纳入偏好测量。
目的
我们旨在了解在标准患者教育干预措施中增加偏好测量是否可以改善决策质量，并在繁忙的临床环境中是否可行。
方法
2011 年 1 月至 2015 年 5 月，从洛杉矶退伍军人事务部（VA）医疗中心泌尿科诊所、Olive View UCLA 医疗中心和 Harbor UCLA 医疗中心招募了患有局灶性前列腺癌的男性（n=122），并将他们随机分配到接受关于前列腺癌治疗的小册子教育或除了小册子之外还接受基于软件的偏好评估。接受偏好评估的男性收到了一份报告，详细说明了他们在与医生一起回顾治疗结果时对治疗结果的偏好的相对强度。参与者在癌症咨询之前和/或之后完成了衡量决策冲突、知识、SDM 和患者对护理满意度的工具。
结果
基线知识得分较低（平均 62%）。决策冲突量表的基线平均总分为 2.3（±0.9），表示中度决策冲突。与仅接受教育的男性相比，接受偏好评估的男性在咨询后决策冲突总分（p=0.023）和感知有效决策制定子量表（p=0.003）显著降低。两组在护理满意度、SDM 和知识方面的改善相似。
结论
在临床环境中进行个体水平的偏好评估是可行的。接受偏好评估的前列腺癌患者对他们的治疗决策更加确定，并报告在做出这些决策时决策冲突的水平降低。
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