Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
J Sleep Res. 2019 Oct;28(5):e12808. doi: 10.1111/jsr.12808. Epub 2018 Dec 13.
Adherence to continuous positive airway pressure (CPAP) treatment tends to be low. Brief validated instruments focusing on shared decision making have not been used in a CPAP context. The aim was to investigate factorial structure, categorical functioning of the response scale and differential item functioning across sub-populations of the CollaboRATE and Sure questionnaires among patients with obstructive sleep apnea (OSA) before CPAP treatment is initiated. A prospective design, including 193 objectively diagnosed (polygraphy) OSA patients (68% men, 59.7 years, SD 11.5) from two CPAP clinics was used. Data were collected with the following questionnaires; Sure, CollaboRATE, Attitudes to CPAP Inventory, Epworth sleepiness scale, minimal insomnia symptoms scale, and hospital anxiety and depression scale. Objective CPAP use was collected after 6 months; 49% demonstrated decisional conflict on SURE and 51% scored low levels of shared decision making on CollaboRATE. Unidimensionality was found for both CollaboRATE (one factor explaining 57.4%) and SURE (one factor explaining 53.7%), as well as local independence. Differential item functioning showed both to be invariant across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. Latent class analyses showed that patients with low decisional conflict and high shared decision making were more adherent to CPAP treatment. CollaboRATE and SURE provided good validity and reliability scores to measure shared decision making and decisional conflict in relation to CPAP treatment. The questionnaires can be used by healthcare personnel as a tool to simplify the assessment of shared decision making.
对持续气道正压通气（CPAP）治疗的依从性往往较低。虽然有一些针对共同决策的简短有效验证工具，但尚未在 CPAP 环境中使用。本研究旨在探讨在开始 CPAP 治疗之前，CollaboRATE 和 Sure 问卷在阻塞性睡眠呼吸暂停（OSA）患者中的因子结构、类别功能和亚人群的差异项目功能。采用前瞻性设计，纳入了来自两个 CPAP 诊所的 193 名经客观诊断（多导睡眠图）的 OSA 患者（68%为男性，59.7 岁，SD 11.5）。收集的资料包括 Sure 问卷、CollaboRATE 问卷、CPAP 态度量表、Epworth 嗜睡量表、最小失眠症状量表和医院焦虑抑郁量表。6 个月后收集客观 CPAP 使用情况；49%的患者在 Sure 上表现出决策冲突，51%的患者在 CollaboRATE 上的共同决策水平较低。CollaboRATE（一个因素解释 57.4%）和 Sure（一个因素解释 53.7%）都发现了单维性，以及局部独立性。差异项目功能表明两者在男性和女性患者中均不变。内部一致性（Cronbach's alpha 0.83）和综合可靠性（0.89）良好。潜在类别分析显示，决策冲突低且共同决策高的患者对 CPAP 治疗的依从性更高。CollaboRATE 和 Sure 提供了良好的有效性和可靠性评分，可用于测量与 CPAP 治疗相关的共同决策和决策冲突。医护人员可以使用这些问卷作为一种工具，简化共同决策的评估。
