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联合分析在55岁及以上患者中引出桡骨远端骨折偏好的可用性和可行性

The Usability and Feasibility of Conjoint Analysis to Elicit Preferences for Distal Radius Fractures in Patients 55 Years and Older.

作者信息

Shapiro Lauren M, Eppler Sara L, Baker Laurence C, Harris Alex S, Gardner Michael J, Kamal Robin N

机构信息

VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.

Department of Health Research & Policy, Stanford University, Stanford, CA.

出版信息

J Hand Surg Am. 2019 Oct;44(10):846-852. doi: 10.1016/j.jhsa.2019.07.010. Epub 2019 Sep 5.

Abstract

PURPOSE

Eliciting patient preferences is one part of the shared decision-making process-a process of decision making focused on the values and preferences of the patient. We evaluated the usability and feasibility of a point-of-care conjoint analysis tool for preference elicitation for shared decision making in the treatment of distal radius fractures in patients over the age of 55 years.

METHODS

Twenty-seven patients 55 years of age or older with a displaced distal radius fracture were recruited from a hand and upper extremity clinic. A conjoint analysis tool was created describing the attributes of care (eg, return of grip strength) of surgical and nonsurgical treatment. This tool was administered to patients to determine their preferences for the treatment attributes when choosing between surgical and nonsurgical treatment. Patients completed a System Usability Scale (SUS) to evaluate usability, and time to complete the tool was measured to evaluate feasibility.

RESULTS

Patients considered the conjoint analysis tool to be usable (SUS, 91.4; SD, 10.9). Mean time to complete the tool was 5.1 minutes (SD, 1.4 minutes). The most important attributes driving the decision for surgical treatment were return of grip strength at 1 year and time spent in a cast or brace. The most important attributes driving the decision for nonsurgical treatment were use of anesthesia during treatment and return of grip strength at 1 year.

CONCLUSIONS

A point-of-care conjoint analysis tool for distal radius fractures in patients 55 years and older can be used to elicit patient preferences to inform the shared decision-making process. Further investigation evaluating the effect of preference elicitation on treatment choice, involvement in decision making, and patient-reported outcomes are needed.

CLINICAL RELEVANCE

A conjoint analysis tool is a simple, structured process physicians can use during shared decision making to highlight trade-offs between treatment options and elicit patient preferences to inform treatment choices.

摘要

目的

引出患者偏好是共同决策过程的一部分,共同决策过程是一种以患者价值观和偏好为重点的决策过程。我们评估了一种即时护理联合分析工具在55岁以上桡骨远端骨折患者共同决策中用于引出偏好的可用性和可行性。

方法

从手部和上肢诊所招募了27名55岁及以上的桡骨远端移位骨折患者。创建了一个联合分析工具,描述手术和非手术治疗的护理属性(如握力恢复)。该工具用于让患者在手术和非手术治疗之间进行选择时确定他们对治疗属性的偏好。患者完成系统可用性量表(SUS)以评估可用性,并测量完成该工具的时间以评估可行性。

结果

患者认为联合分析工具可用(SUS评分91.4;标准差10.9)。完成该工具的平均时间为5.1分钟(标准差1.4分钟)。推动手术治疗决策的最重要属性是1年后握力恢复和石膏或支具佩戴时间。推动非手术治疗决策的最重要属性是治疗期间是否使用麻醉以及1年后握力恢复。

结论

一种用于55岁及以上患者桡骨远端骨折的即时护理联合分析工具可用于引出患者偏好,为共同决策过程提供信息。需要进一步研究评估引出偏好对治疗选择、参与决策和患者报告结局的影响。

临床意义

联合分析工具是一种简单、结构化的过程,医生在共同决策过程中可以使用它来突出治疗方案之间的权衡,并引出患者偏好以指导治疗选择。

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