针对考虑延迟乳房重建的女性的决策辅助工具的开发与测试。
Development and testing of a decision aid for women considering delayed breast reconstruction.
作者信息
Metcalfe Kelly, Zhong Toni, O'Neill Anne C, McCready David, Chan Linda, Butler Kate, Brennenstuhl Sarah, Hofer Stefan O P
机构信息
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada; Women's College Research Institute, 76 Grenville Street, Toronto, ON, Canada.
Division of Plastic & Reconstructive Surgery, Breast Restoration Program, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada; Division of Plastic & Reconstructive Surgery, University of Toronto, 155 College Street, Toronto, ON, Canada; Departments of Surgery and Surgical Oncology, 155 College Street, University of Toronto, Toronto, ON, Canada.
出版信息
J Plast Reconstr Aesthet Surg. 2018 Mar;71(3):318-326. doi: 10.1016/j.bjps.2017.08.027. Epub 2017 Sep 12.
BACKGROUND
The decision to have post-mastectomy breast reconstruction (PMBR) is highly complex and many women feel ill equipped to make this decision. Decision aids have been advocated to promote patient involvement in decision-making by streamlining and standardizing communication between the patient and the health care professional. In this study, we report on the development and testing of a decision aid (DA) for breast cancer survivors considering delayed PMBR.
METHODS
The DA was developed and evaluated in three phases. The first phase included the development of the DA with input and review by practitioners and key stakeholders. The second phase involved pilot testing of the feasibility and acceptability of the DA with a convenience sample of women with delayed PMBR. The third phase involved a pretest/post-test evaluation of the DA for women who were making decisions about their PMBR options.
RESULTS
The DA was developed using the Ottawa Decision Support Framework. In the second phase of the study, 21 women completed the acceptability survey, of whom 100% reported that they would recommend the DA to other women. In the third phase, decisional conflict decreased significantly (p < 0.001) and knowledge increased significantly (p < 0.001) from prior to using the DA to 1-2 weeks after using the DA.
CONCLUSIONS
The DA is feasible and acceptable to women considering delayed PMBR. Furthermore, the DA is effective at reducing decisional conflict and increasing knowledge about delayed PMBR. The DA is an appropriate tool to be used in addition with standard care in women considering PMBR.
背景
决定进行乳房切除术后乳房重建（PMBR）极为复杂，许多女性觉得自己没有足够的能力做出这一决定。人们提倡使用决策辅助工具，通过简化和规范患者与医护人员之间的沟通，促进患者参与决策过程。在本研究中，我们报告了一种针对考虑延迟进行PMBR的乳腺癌幸存者的决策辅助工具（DA）的开发和测试情况。
方法
DA分三个阶段进行开发和评估。第一阶段包括在从业者和关键利益相关者的参与和审查下开发DA。第二阶段对延迟进行PMBR的女性便利样本进行DA的可行性和可接受性试点测试。第三阶段对正在就其PMBR选项做出决策的女性进行DA的预测试/后测试评估。
结果
DA是使用渥太华决策支持框架开发的。在研究的第二阶段，21名女性完成了可接受性调查，其中100%报告称她们会向其他女性推荐该DA。在第三阶段，从使用DA前到使用DA后1 - 2周，决策冲突显著降低（p < 0.001），知识显著增加（p < 0.001）。
结论
对于考虑延迟进行PMBR的女性来说，该DA是可行且可接受的。此外，该DA在减少决策冲突和增加关于延迟PMBR的知识方面有效。该DA是一种适合与考虑PMBR的女性的标准护理一起使用的工具。
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