Jha Swati, Duckett Jonathan
Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
Department of Obstetrics and Gynaecology, Medway Hospital, Windmill Rd, Gillingham, Kent, ME7 5NY, UK.
Int Urogynecol J. 2019 Sep;30(9):1483-1486. doi: 10.1007/s00192-019-03982-1. Epub 2019 Jun 1.
Patient decision aids (PDAs) facilitate shared decision making allowing patients to make decisions about their healthcare that take into account their personal values and preferences. The aim of this study was to establish whether a PDA used in women requiring stress incontinence surgery is helpful to women when making choices about the treatments they choose by using a Decision Conflict Scale (DCS).
Forty-five consecutive women were identified as having stress urinary incontinence and had completed all conservative treatments. All patients included in the study had stress urinary incontinence confirmed on urodynamic testing and were given the PDA at the point where they needed to make a decision about surgery. Following completion of the PDA, patients were given a DCS to complete which measures personal perceptions of uncertainty when making a decision about treatment.
Forty-three out of 45 (95.5%) patients scored 4/4 for the DCS indicating they were sure of their decision. Two patients (4.5%) scored 3/4 and were therefore unsure of their choice. No patient scored < 3 on the DCS. The choice of procedures varied in all the ages and two women opted to have no treatment.
The use of a PDA in the surgical treatment of stress urinary incontinence reduces decision conflict and ensures patients are sure of their decision, understand the information provided as well as the risk benefit ratio of the various options and feel they have adequate support and advice to make a choice.
患者决策辅助工具（PDA）有助于共同决策，使患者能够根据自身价值观和偏好做出有关医疗保健的决策。本研究的目的是通过使用决策冲突量表（DCS）来确定，在需要进行压力性尿失禁手术的女性中使用的PDA，在她们选择治疗方案时是否对其有帮助。
连续纳入45名被确诊为压力性尿失禁且已完成所有保守治疗的女性。纳入研究的所有患者经尿动力学检查确诊为压力性尿失禁，并在需要对手术做出决策时给予PDA。完成PDA后，让患者完成一份DCS，以衡量其在做出治疗决策时对不确定性的个人认知。
45名患者中有43名（95.5%）在DCS上得分为4/4，表明她们对自己的决策很确定。两名患者（4.5%）得分为3/4，因此对自己的选择不确定。没有患者在DCS上得分低于3分。所有年龄段的手术选择各不相同，两名女性选择不进行治疗。
在压力性尿失禁的手术治疗中使用PDA可减少决策冲突，并确保患者对自己的决策有信心，理解所提供的信息以及各种选择的风险效益比，并且觉得自己在做出选择时有足够的支持和建议。
