Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK.
RSSPMCPh&P, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan.
BMC Infect Dis. 2020 Sep 16;20(1):675. doi: 10.1186/s12879-020-05407-7.
Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9-11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health.
A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June-July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12.
People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect.
There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.
以患者为中心的护理是国际公认的优先事项，它描述了患者参与自身护理和治疗决策的过程，以及在服务提供过程中考虑患者的需求和优先事项。需要明确的是，它如何在不同的背景下实际实施。标准的耐多药结核病（MDR-TB）治疗方案冗长、有毒且效果不足。2019 年世界卫生组织指南包括一个更短的（9-11 个月）方案，并建议 MDR-TB 患者参与治疗方案的选择。我们研究了在乌兹别克斯坦卡拉卡尔帕克斯坦由无国界医生组织和卫生部运营的 MDR-TB 项目中，MDR-TB 患者和卫生保健工作者（HCW）对以患者为中心的护理的观点和经验。
2019 年 6 月至 7 月，我们进行了一项包含 24 名 MDR-TB 患者和 20 名 HCW 的 48 次访谈的定性研究。参与者是有目的地招募的，以包括各种治疗经验和专业职位。使用编码对访谈数据进行主题分析，以确定与以患者为中心的护理相关的新兴模式、概念和类别，使用 Nvivo12 软件。
MDR-TB 患者不熟悉共同决策，对承担治疗选择的责任感到不舒服。HCW 被认为具有更多的知识和专业技能，患者信任 HCW 会为他们的利益行事，将适当的治疗方案的选择交给 HCW。HCW 对让患者参与治疗选择表示担忧，他们更愿意让医生做出决定。MDR-TB 患者希望参与讨论他们的治疗，并征求他们的意见，他们愿意选择是否在门诊或住院接受治疗。参与者认为让 MDR-TB 患者了解他们的治疗和疾病非常重要，以增强他们对治疗的准备感和责任感。让患者参与他们的护理被认为可以促进持续的治疗依从性，似乎需要有治疗需求和效果的证据。
人们更倾向于让医生选择治疗方案，这与共同决策不熟悉和医患知识不平衡有关。通过讨论、信息和征求意见让患者参与他们的护理，可以增强他们的所有权和自我责任感，支持他们持续参与治疗。
