Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Surgery, Bernhoven, Uden, The Netherlands.
Health Expect. 2020 Jun;23(3):651-658. doi: 10.1111/hex.13045. Epub 2020 Mar 13.
To investigate the association between patients' preferred treatment and eventual treatment. Second, to compare patients with surgical treatment to watchful waiting in order to identify predictive factors for surgery.
A single-centre retrospective study was performed between December 2015 and August 2018. Patients (≥18 years) who used a patient decision aid (PDA) for gallstones or inguinal hernia were included. After their first surgical consultation, patients received access to an online PDA. The patients' preferred treatment after the PDA was compared with their choice of eventual treatment. Multivariable regression analyses were performed for predictive factors for surgery.
In total, 567 patients with gallstones and 585 patients with an inguinal hernia were included. Of the patients with gallstones, 121 (21%) preferred watchful waiting, 367 (65%) preferred surgery, and 79 (14%) were not sure. The patients' preferred treatment was performed in 85.9%. Frequent pain attacks (OR 2.1, 95% CI 1.1-3.9, P = .020) and preference for surgery (OR 4.4, 95% CI 1.9-10.1, P = .001) independently predicted surgery. Of the patients with an inguinal hernia, 77 (13.2%) preferred watchful waiting, 452 (78.8%) preferred surgery, and 56 (9.6%) were not sure. The patients' preferred treatment was performed in 86.0%. The preference for surgery (OR 5.2, 95% CI 2.5-10.6, P < .001) independently predicted surgery and worry about complications predicted avoidance of surgery (OR 0.5, 95% CI 0.2-1.0, P = .037).
This study, reflecting current clinical care, shows that patients' preferred treatment after using a PDA matches their eventual treatment choice in 86% of patients with gallstones or an inguinal hernia. In these patients, symptoms and patients' preference for surgery independently predicts eventual choice of surgery.
探讨患者首选治疗与最终治疗的关系。其次，比较接受手术治疗和观察等待的患者，以确定手术的预测因素。
这是一项 2015 年 12 月至 2018 年 8 月间在单一中心进行的回顾性研究。纳入使用患者决策辅助工具（PDA）评估胆囊结石或腹股沟疝的患者（≥18 岁）。在他们的第一次手术咨询后，患者可以访问在线 PDA。将 PDA 后患者的首选治疗与最终选择的治疗进行比较。对手术的预测因素进行多变量回归分析。
共纳入 567 例胆囊结石患者和 585 例腹股沟疝患者。在胆囊结石患者中，121 例（21%）首选观察等待，367 例（65%）首选手术，79 例（14%）不确定。85.9%的患者接受了首选治疗。频繁的疼痛发作（OR 2.1，95%CI 1.1-3.9，P=.020）和对手术的偏好（OR 4.4，95%CI 1.9-10.1，P=.001）独立预测手术。在腹股沟疝患者中，77 例（13.2%）首选观察等待，452 例（78.8%）首选手术，56 例（9.6%）不确定。86.0%的患者接受了首选治疗。对手术的偏好（OR 5.2，95%CI 2.5-10.6，P<.001）独立预测手术，对并发症的担忧预测手术的回避（OR 0.5，95%CI 0.2-1.0，P=.037）。
这项研究反映了当前的临床护理情况，表明在胆囊结石或腹股沟疝患者中，86%的患者使用 PDA 后首选的治疗方法与最终的治疗选择相匹配。在这些患者中，症状和患者对手术的偏好独立预测最终手术选择。
