医生对患者生活质量目标的反应。

Physicians' Response to Patients' Quality-of-Life Goals.

机构信息

From Family and Preventive Medicine, Springfield Family Medicine, Springfield, OR (BAP); Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZJN); University of Oklahoma College of Medicine, Oklahoma City, OK (AA, RT); George Lynn Cross Emeritus Professor of Family and Preventive Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK (JWM)

出版信息

J Am Board Fam Med. 2020 Jan-Feb;33(1):71-79. doi: 10.3122/jabfm.2020.01.190169.

DOI:10.3122/jabfm.2020.01.190169

PMID:31907248

Abstract

PURPOSE

Patients are able to participate in quality-of-life (QOL) discussions, but clinicians struggle to incorporate this information into encounters and shared decision making. We designed a study to determine if a clinician-initiated prompt could make patient visits more goal directed.

METHODS

Patients were given a previsit questionnaire that included QOL questions. Physicians in the control were given no further prompting. The intervention physicians were prompted to ask a QOL question: what things are you unable to do because of your health problems today? A 2-pronged design was used: 1 prepost group where 3 physicians participated in 5 control and 5 intervention encounters (n = 30) and a randomized group in which 11 physicians and their patients were randomly assigned to control or intervention groups (n = 30). Video recordings of the encounters were reviewed to determine if QOL goals were mentioned and if they were utilized in decision making.

RESULTS

Fifty-seven (95%) of the 60 patients provided written answers to at least 1 of the QOL questions on the intake form. QOL goals were mentioned during intervention encounters more often than in control groups. QOL information was used in shared decision making in only 4 of the 30 (13%) intervention encounters.

CONCLUSIONS

Physicians were able to engage in QOL discussions with their patients, but did not translate that information to medical decision making. More research is needed to understand why clinicians opt not to use QOL information and how to make communication more goal directed.

摘要

目的

患者能够参与生活质量（QOL）讨论，但临床医生在将这些信息纳入就诊和共同决策方面存在困难。我们设计了一项研究，以确定临床医生主动提示是否可以使患者就诊更有目标。

方法

患者在就诊前填写一份调查问卷，其中包括 QOL 问题。对照组的医生没有得到进一步的提示。干预组的医生被提示询问 QOL 问题：由于您今天的健康问题，您有哪些事情无法完成？采用了两部分设计：1）3 名医生参与了 5 次对照组和 5 次干预组的就诊（n = 30）的预-后组；2）11 名医生及其患者随机分配到对照组或干预组（n = 30）的随机组。审查就诊的视频记录，以确定是否提到了 QOL 目标以及是否将其用于决策制定。