Ong Hui Ling, Sokolova Inna, Bekarma Holly, Curtis Claire, Macdonald Alastair, Agur Wael
University of Glasgow, Glasgow, UK.
University Hospital Crosshouse, NHS Ayrshire & Arran, Kilmarnock, UK.
Int Urogynecol J. 2019 Dec;30(12):2013-2022. doi: 10.1007/s00192-019-04047-z. Epub 2019 Aug 3.
Following the design, face validation and publication of a novel PDA for women considering SUI surgery, the main objective of the study is to evaluate the usefulness of SUI-PDA© by using a validated tool to obtain patient feedback.
From July 2018 to March 2019, the PDA, already incorporated into the patient care pathway, was objectively evaluated using the Decisional Conflict Scale (DCS) to determine patients' views. Patients recorded their values and reasons for requests and declines of treatment. The total DCS score, scores from each DCS subgroup and individual patient responses were calculated and analysed.
The mean age of the first 20 patients to complete the DCS was 54 years, the mean BMI was 30.1 and the median parity was 3. The average total DCS score was only 9.29 out of 100 (range 0-29.69) suggesting that the PDA was quite useful for patients considering SUI surgery. Overall, the PDA had largely favourable responses across all five DCS subgroups. The 'informed' subgroup had the best score (6.67) while the 'uncertainty' subgroup had the least favourable score (14.58). Despite the procedure pause, the mesh tape option remained on the PDA; however, no patient had chosen this option, with a large proportion citing 'safety' issues as the main reason. Bulking agent injections were the most popular choice (40.0%) and the most commonly performed procedures (50.0%) mainly because of quicker 'recovery'. The second most popular participant choice was colposuspension (35.0%) followed by autologous fascial sling (25.0%), with women citing 'efficacy' as the main reason behind their choice.
SUI-PDA© was reported by patients and clinicians to be useful with clinical decision-making for SUI surgery. Further validation in a larger patient group is underway.
在设计、进行表面效度验证并发表一款针对考虑行压力性尿失禁（SUI）手术女性的新型个人数字助理（PDA）之后，本研究的主要目的是通过使用一个经过验证的工具来获取患者反馈，以评估SUI - PDA©的实用性。
从2018年7月至2019年3月，使用决策冲突量表（DCS）对已纳入患者护理流程的PDA进行客观评估，以确定患者的观点。患者记录他们对于治疗请求和拒绝的价值观及原因。计算并分析DCS总分、每个DCS亚组的分数以及个体患者的回答。
完成DCS评估的前20名患者的平均年龄为54岁，平均体重指数（BMI）为30.1，中位产次为3。DCS总分平均仅为100分中的9.29分（范围0 - 29.69），表明该PDA对考虑行SUI手术的患者相当有用。总体而言，PDA在所有五个DCS亚组中大多获得了积极反馈。“信息充分”亚组得分最高（6.67），而“不确定性”亚组得分最不理想（14.58）。尽管手术暂停，但PDA上仍保留了网带选项；然而，没有患者选择此选项，很大一部分患者将“安全性”问题作为主要原因。填充剂注射是最受欢迎的选择（40.0%），也是最常进行的手术（50.0%），主要是因为“恢复”更快。参与者的第二大受欢迎选择是阴道膀胱颈悬吊术（35.0%），其次是自体筋膜吊带术（25.0%），女性将“疗效”作为其选择背后的主要原因。
患者和临床医生报告SUI - PDA©对SUI手术的临床决策有用。正在对更大规模的患者群体进行进一步验证。
