The David Geffen School of Medicine at UCLA, Los Angeles, CA.
The David Geffen School of Medicine at UCLA, Los Angeles, CA; UCLA Department of Urology, Los Angeles, CA.
Urology. 2019 Nov;133:109-115. doi: 10.1016/j.urology.2019.07.023. Epub 2019 Jul 31.
To measure decisional quality, physician loyalty, and treatment preference in patients diagnosed with urolithiasis, a "preference-sensitive" condition, to identify areas of improvement to be addressed by a targeted shared decision-making intervention.
We identified patients who presented for an initial consultation for urolithiasis from March 2016 to May 2017. Patients completed a 24-item patient experience questionnaire after the consultation which assessed decisional quality domains, physician loyalty, and treatment preference. We summarized treatment preferences before and after the consultation and described the changes.
Among the total of 113 patients who met inclusion criteria, 78 (69%) patients chose to participate. Thirty-six (46%) of those patients had evidence of decisional conflict and 42 (54%) did not. Only 1 in 5 patients experiencing decisional conflict reported knowing the benefits and risks of each treatment option. Patients with decisional conflict reported lower perceived shared decision-making, treatment satisfaction, and urolithiasis knowledge. Physician loyalty was lower among patients with decisional conflict as well. Thirty-nine percent of them were 'Promoters' of their urologist, compared to 71% of patients without decisional conflict. Sixty-four percent of patients without decisional conflict identified a treatment preference before consultation, while only 17% of patients who experienced decisional conflict were able to do so.
Many patients with urolithiasis experience decisional conflict and are unsure of their preferences when making a treatment choice. Uncertainty can correlate with low physician loyalty after consultation. This population may benefit from a shared decision-making intervention that improves decisional quality while incorporating patient-specific preferences.
测量患有肾结石（一种“偏好敏感”疾病）的患者的决策质量、医师忠诚度和治疗偏好，以确定需要通过有针对性的共享决策干预来解决的改进领域。
我们从 2016 年 3 月至 2017 年 5 月期间确定了因肾结石就诊的初始咨询患者。患者在咨询后完成了 24 项患者体验问卷，评估了决策质量领域、医师忠诚度和治疗偏好。我们总结了咨询前后的治疗偏好，并描述了变化情况。
在符合纳入标准的 113 名患者中，有 78 名（69%）患者选择参与。其中 36 名（46%）患者存在决策冲突的证据，而 42 名（54%）患者没有。仅有 1/5 经历决策冲突的患者表示了解每种治疗方案的获益和风险。存在决策冲突的患者报告的共同决策、治疗满意度和肾结石知识感知较低。存在决策冲突的患者对医师的忠诚度也较低。其中 39%是他们的泌尿科医生的“拥护者”，而没有决策冲突的患者中这一比例为 71%。64%的无决策冲突患者在咨询前确定了治疗偏好，而只有 17%的存在决策冲突的患者能够做到这一点。
许多患有肾结石的患者在做出治疗选择时会经历决策冲突并且不确定自己的偏好。不确定性可能与咨询后医师忠诚度较低相关。该人群可能受益于一种共享决策干预措施，该措施可提高决策质量并纳入患者特定的偏好。
