Department of Geriatric Medicine, Radboud university medical center, Nijmegen, the Netherlands.
Department of Internal Medicine, Nordland Hospital Trust, Bodø, Norway.
Patient Educ Couns. 2018 Oct;101(10):1767-1774. doi: 10.1016/j.pec.2018.06.005. Epub 2018 Jun 13.
To identify determinants of older patients' perceptions of involvement in decision-making on colorectal (CRC) or pancreatic cancer (PC) treatment, and to compare these with determinants of observers' perceptions.
Patients' perceptions of involvement were constructed by the 9-item SDM questionnaire (SDM-Q-9) and a Visual Analogue Scale for Involvement (VAS-I). Observers' perceptions were constructed by the OPTION5, OPTION12, and MAPPIN'SDM. Convergent validities were calculated between the patient-sided and observer instruments using Spearman's correlation coefficient. Linear regression was used to identify determinants per criterion.
58 CRC and 22 PC patients were included (mean age: 71.8 ± 5.2 years, 45.0% female). No significant correlations were found between the patient-sided and observer instruments. Patients' impression of involvement was influenced by patient characteristics such as quality of life and satisfaction, while observers' perceptions mainly referred to encounter characteristics such as the mean duration of consultations and general communication skills.
Due to evident differences in determinants, older CRC/PC patients' and observers' perceptions of involvement should both be collected in evaluating the quality of medical decision-making.
General communication skills should be integrated in SDM training interventions. New SDM measurement tools for patients are needed to sufficiently discriminate between the constructs of involvement and satisfaction.
确定影响老年患者对结直肠癌（CRC）或胰腺癌（PC）治疗决策参与度看法的因素，并将其与观察者看法的影响因素进行比较。
通过 9 项决策参与度问卷（SDM-Q-9）和参与度视觉模拟量表（VAS-I）构建患者的参与度感知，通过 OPTION5、OPTION12 和 MAPPIN'SDM 构建观察者的参与度感知。采用 Spearman 相关系数计算患者侧和观察者工具之间的收敛有效性。采用线性回归确定每个标准的决定因素。
纳入 58 例 CRC 和 22 例 PC 患者（平均年龄：71.8±5.2 岁，45.0%为女性）。患者侧和观察者工具之间未发现显著相关性。患者对参与度的印象受到患者特征的影响，如生活质量和满意度，而观察者的看法主要涉及就诊特征，如咨询的平均持续时间和一般沟通技巧。
由于决定因素明显不同，在评估医疗决策质量时，应同时收集老年 CRC/PC 患者和观察者对参与度的看法。
应将一般沟通技巧纳入 SDM 培训干预中。需要新的患者 SDM 测量工具来充分区分参与度和满意度的结构。
