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一项关于肺癌诊断中共享决策的前瞻性队列研究:使用患者决策辅助工具的影响。

A prospective cohort study of shared decision making in lung cancer diagnostics: Impact of using a patient decision aid.

机构信息

Department of Internal Medicine, The Lung Cancer Diagnostic Organization, Lillebaelt Hospital, Vejle, Denmark.

Department of Internal Medicine, Lillebaelt Hospital, Kolding, Denmark.

出版信息

Patient Educ Couns. 2019 Nov;102(11):1961-1968. doi: 10.1016/j.pec.2019.05.018. Epub 2019 May 16.

Abstract

OBJECTIVE

The objective of this study was to describe the impact on patient-reported outcomes of introducing Shared Decision Making (SDM) and a Patient Decision Aid (PtDA) in the initial process of lung cancer diagnostics.

METHODS

We conducted a prospective cohort study, where a control cohort was consulted according to usual clinical practice. After introducing SDM through a PtDA and training of the staff, the SDM cohort was enrolled in the study. All patients completed four questionnaires: the Decisional Conflict Scale (DCS) before and after the consultation, the CollaboRATE scale after the consultation, and the Decision Regret Scale (DRS).

RESULTS

Patients exposed to SDM and a PtDA had significantly improved DCS scores after the consultation compared to the control group (a difference of 10.26, p = 0.0128) and significantly lower DRS scores (a difference of 8.98, p = 0.0197). Of the 82 control patients and 52 SDM patients 29% and 54%, respectively, gave the maximum score on the CollaboRATE scale (Pearson's chi 8.0946, p = 0.004).

CONCLUSION

The use of SDM and a PtDA had significant positive impact on patient-reported outcomes.

PRACTICE IMPLICATIONS

Our results may encourage the increased uptake of SDM in the initial process of lung cancer diagnostics.

摘要

目的

本研究旨在描述在肺癌诊断初始阶段引入共享决策(SDM)和患者决策辅助工具(PtDA)对患者报告结局的影响。

方法

我们进行了一项前瞻性队列研究,其中对照队列按照常规临床实践进行咨询。在通过 PtDA 引入 SDM 并对员工进行培训后,将 SDM 队列纳入研究。所有患者完成了四个问卷:咨询前后的决策冲突量表(DCS)、咨询后的 CollaboRATE 量表和决策后悔量表(DRS)。

结果

与对照组相比,接受 SDM 和 PtDA 的患者在咨询后 DCS 评分显著提高(差异为 10.26,p=0.0128),DRS 评分显著降低(差异为 8.98,p=0.0197)。在 82 名对照患者和 52 名 SDM 患者中,分别有 29%和 54%的患者在 CollaboRATE 量表上获得了最高分(Pearson's chi 8.0946,p=0.004)。

结论

SDM 和 PtDA 的使用对患者报告结局产生了显著的积极影响。

实践意义

我们的结果可能鼓励在肺癌诊断的初始阶段增加 SDM 的使用。

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