Savitz Samuel T, Dobler Claudia C, Shah Nilay D, Bennett Antonia V, Bailey Stacy Cooper, Dusetzina Stacie B, Jones W Schuyler, Stearns Sally C, Montori Victor M
Kaiser Permanente Division of Research, US.
Mayo Clinic, US.
EGEMS (Wash DC). 2019 Aug 9;7(1):42. doi: 10.5334/egems.306.
Stable angina patients have difficulty understanding the tradeoffs between treatment alternatives. In this analysis, we assessed treatment planning conversations for stable angina to determine whether inadequate health literacy acts as a barrier to communication that may partially explain this difficulty.
We conducted a descriptive analysis of patient questionnaire data from the PCI Choice Trial. The main outcomes were the responses to the Decisional Conflict Scale and the proportion of correct responses to knowledge questions about stable angina. We also conducted a qualitative analysis on recordings of patient-clinician discussions about treatment planning. The recordings were coded with the OPTION12 instrument for shared decision-making. Two analysts independently assessed the number and types of patient questions and expressions of preferences.
Patient engagement did not differ by health literacy level and was generally low for all patients with respect to OPTION12 scores and the number of questions related to clinical aspects of treatment. Patients with inadequate health literacy had significantly higher decisional conflict. However, the proportion of knowledge questions answered correctly did not differ significantly by health literacy level.
Patients with inadequate health literacy had greater decisional conflict but no difference in knowledge compared to patients with adequate health literacy. Inadequate health literacy may act as a barrier to communication, but gaps were found in patient engagement and knowledge for patients of all health literacy levels. The recorded patient-clinician encounters and the health literacy measure were valuable resources for conducting research on care delivery.
稳定型心绞痛患者难以理解治疗方案之间的权衡。在本分析中，我们评估了稳定型心绞痛的治疗规划谈话，以确定健康素养不足是否会成为沟通障碍，这可能部分解释了这种困难。
我们对PCI选择试验中的患者问卷数据进行了描述性分析。主要结果是对决策冲突量表的回答以及对稳定型心绞痛知识问题正确回答的比例。我们还对患者与临床医生关于治疗规划讨论的录音进行了定性分析。这些录音用用于共同决策的OPTION12工具进行编码。两名分析人员独立评估患者问题的数量和类型以及偏好表达。
患者参与度在不同健康素养水平之间没有差异，并且就OPTION12评分和与治疗临床方面相关的问题数量而言，所有患者的参与度普遍较低。健康素养不足的患者决策冲突显著更高。然而，正确回答知识问题的比例在不同健康素养水平之间没有显著差异。
与健康素养充足的患者相比，健康素养不足的患者决策冲突更大，但知识水平没有差异。健康素养不足可能会成为沟通障碍，但在所有健康素养水平的患者的参与度和知识方面都存在差距。记录的患者与临床医生的交流以及健康素养测量是进行护理研究的宝贵资源。
