Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California.
David Geffen School of Medicine at UCLA, Los Angeles, California.
J Clin Sleep Med. 2021 Feb 1;17(2):121-128. doi: 10.5664/jcsm.8798.
Person-centered obstructive sleep apnea (OSA) care is a collaborative approach that is respectful of an individual's health priorities. Informed decision-making is essential to person-centered care, especially as patients age. In a feasibility study, we evaluated the effects of a new decision aid (Decide2Rest) on OSA treatment decision-making in older adults.
Patients (aged ≥ 60 years) with newly diagnosed OSA were recruited from two health care systems and randomized either to Decide2Rest or to a control program. Postintervention outcomes included 1) Decisional Conflict Scale (0-100, where 0 = low and 100 = high conflict), which measures perceptions of uncertainty, whether decisions reflect what matters most to patients, and whether patients feel supported in decision-making; 2) Preparation for Decision-Making scale (0-100, where 0 = least and 100 most prepared); and 3) OSA knowledge (0-100, where 0 = poor and 100 = outstanding). Multivariable linear regression models examined relationships between Decide2Rest and outcomes (Decisional Conflict Scale, Preparation for Decision-Making, OSA knowledge).
Seventy-three patients were randomized to Decide2Rest (n = 36; mean age, 69 years; 72% male) vs control (n = 37; mean age, 69 years; 70% male). Results from the regressions, controlling for study site, indicate that the Decide2Rest program resulted in less decisional conflict (20.5 vs 32.7 on the Decisional Conflict Scale; P = .014), more preparedness for decision-making (87.8 vs 66.2 on the Preparation for Decision-Making scale; P < .001), and greater OSA knowledge (75.1 vs 65.3 OSA knowledge score; P = .04) scores than in the control group.
The Decide2Rest program promotes person-centered OSA decision-making for older patients with newly diagnosed OSA. Future studies are needed to optimize implementation of the program.
Registry: ClinicalTrials.gov, Name: Improving Older Adults' Decision-Making for OSAT (eDecide2Rest); URL: https://clinicaltrials.gov/ct2/show/NCT03138993; Identifier: NCT03138993.
以人为中心的阻塞性睡眠呼吸暂停（OSA）护理是一种尊重个人健康优先事项的协作方法。知情决策对于以人为中心的护理至关重要，尤其是随着患者年龄的增长。在一项可行性研究中，我们评估了一种新的决策辅助工具（Decide2Rest）对老年患者 OSA 治疗决策的影响。
从两个医疗保健系统招募了新诊断为 OSA 的患者（年龄≥60 岁），并将其随机分为 Decide2Rest 组或对照组。干预后的结果包括：1）决策冲突量表（0-100，其中 0 表示低冲突，100 表示高冲突），用于衡量对不确定性的感知、决策是否反映对患者最重要的事项，以及患者在决策中是否感到支持；2）决策准备量表（0-100，其中 0 表示准备程度最低，100 表示准备程度最高）；3）OSA 知识量表（0-100，其中 0 表示较差，100 表示出色）。多变量线性回归模型分析了 Decide2Rest 与结果（决策冲突量表、决策准备量表、OSA 知识）之间的关系。
73 名患者被随机分配到 Decide2Rest 组（n=36；平均年龄 69 岁；72%为男性）和对照组（n=37；平均年龄 69 岁；70%为男性）。对研究地点进行控制的回归结果表明，Decide2Rest 计划导致决策冲突减少（决策冲突量表上的 20.5 分与 32.7 分相比；P=0.014），决策准备度提高（决策准备量表上的 87.8 分与 66.2 分相比；P＜0.001），OSA 知识得分增加（OSA 知识量表上的 75.1 分与 65.3 分相比；P=0.04），而对照组则没有。
Decide2Rest 计划促进了新诊断为 OSA 的老年患者的以人为中心的 OSA 决策。未来需要进一步研究以优化该计划的实施。
注册机构：ClinicalTrials.gov，名称：改善老年人对 OSA 的决策（eDecide2Rest）；网址：https://clinicaltrials.gov/ct2/show/NCT03138993；标识符：NCT03138993。
