Shum Jennifer W H, Lam Wendy W T, Choy Bonnie N K, Chan Jonathan C H, Ho Wing Lau, Lai Jimmy S M
Department of Ophthalmology, The University of Hong Kong, Hong Kong, China.
School of Public Health, The University of Hong Kong, Hong Kong, China.
BMJ Open Ophthalmol. 2017 Dec 14;2(1):e000100. doi: 10.1136/bmjophth-2017-000100. eCollection 2017.
A patient decision aid (PDA) is a tool for shared decision making (SDM), which emphasises patient empowerment. It is useful in chronic diseases and when there are multiple, no best single treatment option. Although SDM is prevalent in Western countries, its use is limited in Chinese societies, where the adoption of a paternalistic approach is strong. Here, we report the development, acceptance and pilot test results of a PDA targeted at Chinese patients with primary open-angle glaucoma (POAG).
We developed a PDA designed for use in Chinese patients with POAG. Recruited subjects were given our PDA. Baseline evaluation included decision conflict scale (DCS), validated glaucoma adherence questionnaires and glaucoma knowledge questionnaire. Subjects were briefed through the PDA and instructed to read it that day. Three to four weeks later, follow-up questionnaire as described above were conducted with the addition of acceptance questionnaires.
Data from 65 subjects were available. The PDA was well received among subjects. DCS improved from 48.9±20.4 at baseline to 34.3±20.3 during follow-up, with P<0.01. Validated medication adherence questionnaires and knowledge showed improvement from baseline, which was statistically significant.
The use of PDA among Chinese subjects with POAG demonstrated positive reception and acceptance. Evaluation of its initial effects shows improvement in DCS, medication adherence and glaucoma knowledge. The implementation of SDM and PDA among Chinese subjects with POAG is encouraged. Future studies with randomised design and later evaluation time points can further reveal the impacts of PDA among Chinese subjects with POAG.
患者决策辅助工具（PDA）是一种用于共同决策（SDM）的工具，强调患者赋权。它在慢性病以及存在多种治疗选择且无最佳单一治疗方案的情况下很有用。虽然共同决策在西方国家很普遍，但在中国社会其应用有限，因为家长式方法的采用较为强烈。在此，我们报告针对中国原发性开角型青光眼（POAG）患者的一种PDA的开发、接受情况及试点测试结果。
我们开发了一种专为中国POAG患者设计的PDA。招募的受试者被给予我们的PDA。基线评估包括决策冲突量表（DCS）、经过验证的青光眼依从性问卷和青光眼知识问卷。通过PDA向受试者进行简要介绍，并指示他们当天阅读。三到四周后，进行上述随访问卷，并增加接受情况问卷。
有65名受试者的数据可用。该PDA在受试者中受到好评。DCS从基线时的48.9±20.4改善至随访期间的34.3±20.3，P<0.01。经过验证的药物依从性问卷和知识从基线时有改善，具有统计学意义。
在中国POAG受试者中使用PDA显示出积极的接受度。对其初始效果的评估显示DCS、药物依从性和青光眼知识有所改善。鼓励在中国POAG受试者中实施共同决策和PDA。未来采用随机设计和更晚评估时间点的研究可以进一步揭示PDA对中国POAG受试者的影响。
