Division of General Internal Medicine (DGIM), Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA (KRS, SJA, YC, LHS).
Orthopedics MGH, HMS Boston, MA (AF, HM, HR, TC).
Med Decis Making. 2018 Nov;38(8):1018-1026. doi: 10.1177/0272989X18801308.
A goal of shared decision making (SDM) is to ensure patients are well informed and receive preferred treatments. However, the relationship between SDM and health outcomes is not clear.
The purpose was to examine whether patients who are well informed and receive their preferred treatment have better health outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study at an academic medical center surveyed new patients with knee or hip osteoarthritis, herniated disc, or spinal stenosis 1 week after seeing a specialist and again 6 months later. Main Outcomes and Measures. The survey assessed knowledge, preferred treatment, and quality of life (QoL). The percentage of patients who were well informed and received preferred treatment was calculated (informed, patient centered [IPC]). A follow-up survey assessed QoL, decision regret, and satisfaction. Regression analyses with generalized estimating equations to account for clustering tested a priori hypotheses that patients who made IPC decisions would have higher QoL.
Response rate was 70.3% (652/926) for initial and 85% (551/648) for follow-up. The sample was 63.9 years old, 52.8% were female, 62.6% were college educated, and 49% had surgery. One-third (37.4%) made IPC decisions. Participants who made IPC decisions had significantly better overall (0.05 points (SE 0.02) for EQ-5D, P = 0.004) and disease-specific quality of life (4.22 points [SE 1.82] for knee, P = 0.02; 4.46 points [SE 1.54] for hip, P = 0.004; and 6.01 points [SE 1.51] for back, P < 0.0001), higher satisfaction and less regret.
Observational study at a single academic center with limited diversity.
Well-informed patients who receive their preferred treatment also had better health outcomes and higher satisfaction.
共同决策（SDM）的目标是确保患者充分知情并接受首选治疗。然而，SDM 与健康结果之间的关系尚不清楚。
本研究旨在探讨充分知情并接受首选治疗的患者是否具有更好的健康结果。
设计、地点和参与者：这是一项在学术医疗中心进行的前瞻性队列研究，对新诊断为膝关节或髋关节骨关节炎、椎间盘突出或脊柱狭窄的患者，在就诊后 1 周和 6 个月后进行调查。主要结局和措施：调查评估了知识、首选治疗和生活质量（QoL）。计算了充分知情且接受首选治疗的患者比例（知情、以患者为中心[IPC]）。后续调查评估了 QoL、决策后悔和满意度。使用广义估计方程进行回归分析，以考虑聚类，检验了患者做出 IPC 决策会具有更高 QoL 的假设。
初始调查的应答率为 70.3%（926 例中的 652 例），随访的应答率为 85%（648 例中的 551 例）。样本的平均年龄为 63.9 岁，52.8%为女性，62.6%接受过大学教育，49%接受了手术。三分之一（37.4%）的患者做出了 IPC 决策。做出 IPC 决策的患者在总体（EQ-5D 评分 0.05 分[SE 0.02]，P=0.004）和疾病特异性生活质量（膝关节评分 4.22 分[SE 1.82]，P=0.02；髋关节评分 4.46 分[SE 1.54]，P=0.004；和背部评分 6.01 分[SE 1.51]，P<0.0001）方面均有显著改善，且满意度更高，后悔感更少。
单中心观察性研究，多样性有限。
充分知情且接受首选治疗的患者具有更好的健康结果和更高的满意度。
