Yale University School of Medicine, New Haven, Connecticut.
Global Healthy Living Foundation, Upper Nyack, New York.
Arthritis Care Res (Hoboken). 2019 May;71(5):629-637. doi: 10.1002/acr.23684. Epub 2019 Apr 8.
In this proof-of-concept study, we sought to evaluate whether a value clarification tool enabling patients to view a set of rheumatoid arthritis (RA) treatment preference phenotypes could be used to support shared decision-making at the point-of-care.
We conducted a pretest/post test study. English-speaking patients with RA presenting to their scheduled outpatient visits were asked to participate. Visits for patients with active RA were transcribed. Shared decision-making components were measured using a quantitative coding scheme based on an established model of shared decision-making.
Forty-six visits were included in the pretest and 40 in the post test phases. Providers offered more disease-modifying antirheumatic drugs (DMARDs) (2 or more) in the post test visits (60%) compared to the pretest visits (47.8%). Overall, more patients vocalized their values and/or preferences in the post test visits compared to the pretest visits for treatment escalation decisions including a choice of 1 new DMARD (90.9% versus 56.3%), 2 or more new DMARDs (95.8% versus 86.4%), as well as prednisone (87.5% versus 66.7%). Providers were also more likely to base their recommendations on patients' values and/or preferences in the post test (100% of 6 visits) than the pretest (64.3% of 14 visits) phases during visits in which a recommendation was made. The mean ± SD length of the visit was 29.9 ± 11.6 minutes and 25.1 ± 10.7 minutes in the pretest and post test phases, respectively.
This study provides an early indication that a value clarification tool allowing patients to consider a set of preference phenotypes can support shared decision-making at the point-of-care without extending visit time.
在这项概念验证研究中，我们旨在评估一种能够使患者查看一组类风湿关节炎（RA）治疗偏好表型的价值观澄清工具，是否可以用于在护理点支持共同决策。
我们进行了一项预测试/后测试研究。我们邀请了正在预约门诊就诊的讲英语的 RA 患者参与研究。记录了 RA 活动期患者的就诊情况。使用基于共同决策模型的定量编码方案来衡量共同决策的组成部分。
共纳入 46 例预测试访视和 40 例后测试访视。在后测试访视中，医生提供了更多的疾病修饰抗风湿药物（DMARDs）（2 种或更多）（60%），而在前测试访视中仅为 47.8%。总体而言，在后测试访视中，与前测试访视相比，更多的患者在治疗升级决策中表达了自己的价值观和/或偏好，包括选择 1 种新的 DMARD（90.9%对 56.3%）、2 种或更多新的 DMARD（95.8%对 86.4%），以及泼尼松（87.5%对 66.7%）。在后测试访视中（6 次就诊中的 100%），医生也更有可能根据患者的价值观和/或偏好来推荐治疗方案，而在前测试访视中（14 次就诊中的 64.3%）。在做出推荐的访视中，医生推荐的依据为患者的价值观和/或偏好。预测试和后测试访视的就诊时间平均长度分别为 29.9±11.6 分钟和 25.1±10.7 分钟。
这项研究初步表明，一种允许患者考虑一组偏好表型的价值观澄清工具可以在不延长就诊时间的情况下，在护理点支持共同决策。
