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择期腹腔镜胆囊切除术中患者报告的结局

Patient reported outcomes in elective laparoscopic cholecystectomy.

作者信息

Mak Malcolm H W, Chew Woon Ling, Junnarkar Sameer P, Woon Winston W L, Low Jee-Keem, Huey Terence C W, Shelat Vishalkumar G

机构信息

Department of General Surgery, Tan Tock Seng Hospital, Singapore.

School of Biological Sciences, Nanyang Technological University, Singapore.

出版信息

Ann Hepatobiliary Pancreat Surg. 2019 Feb;23(1):20-33. doi: 10.14701/ahbps.2019.23.1.20. Epub 2019 Feb 28.

Abstract

BACKGROUNDS/AIMS: Traditional outcome measures (e.g., length of hospital stay, morbidity, and mortality) are used to determine the quality of care, but these may not be most important to patients. It is unclear which outcomes matter to patients undergoing elective laparoscopic cholecystectomy (ELC). We aim to identify patient-reported outcome measures (PROM) which patients undergoing ELC valued most.

METHODS

A 45-item questionnaire with Four-point Likert-type questions developed from prior literature review, prospectively administered to patients treated with ELC at a tertiary institution in Singapore.

RESULTS

Seventy-five patients participated. Most essential factors were technical skill and experience level of a surgeon, long-term quality of life (QoL), patient involvement in decision-making, communication skill of a surgeon, cleanliness of the ward environment, and standards of nursing care. Least important factors were hospitalization leave duration, length of hospital stay, a family's opinion of the hospital, and scar cosmesis. Employed patients were more likely to find hospitalization leave duration (<0.001) and procedure duration (=0.042) important. Younger patients (=0.048) and female gender (=0.003) were more likely to perceive scar cosmesis as important.

CONCLUSIONS

Patients undergoing ELC value long-term QoL, surgeon technical skill and experience level, patient involvement in decision-making, surgeon communication skill, cleanliness of the ward environment, and nursing care standards. Day-case surgery, medical leave, family opinion of hospital, and scar cosmesis were least important. Understanding what patients value will help guide patient-centric healthcare delivery.

摘要

背景/目的:传统的结果指标(如住院时间、发病率和死亡率)用于确定医疗质量,但这些指标对患者而言可能并非最为重要。目前尚不清楚哪些结果指标对接受择期腹腔镜胆囊切除术(ELC)的患者最为重要。我们旨在确定接受ELC的患者最看重的患者报告结局指标(PROM)。

方法

根据先前的文献综述制定了一份包含45个条目的问卷,问卷采用四点李克特量表式问题,前瞻性地发放给新加坡一家三级医疗机构中接受ELC治疗的患者。

结果

75名患者参与了研究。最重要的因素是外科医生的技术水平和经验、长期生活质量(QoL)、患者参与决策、外科医生的沟通技巧、病房环境清洁度以及护理标准。最不重要的因素是病假时长、住院时间、家属对医院的看法以及疤痕美观度。在职患者更有可能认为病假时长(<0.001)和手术时长(=0.042)很重要。年轻患者(=0.048)和女性(=0.003)更有可能认为疤痕美观度很重要。

结论

接受ELC的患者看重长期生活质量、外科医生的技术水平和经验、患者参与决策、外科医生的沟通技巧、病房环境清洁度以及护理标准。日间手术、病假、家属对医院的看法以及疤痕美观度最不重要。了解患者看重的因素将有助于指导以患者为中心的医疗服务提供。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/12c6/6405362/0c8042845746/ahbps-23-20-g001.jpg

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