改善阻塞性睡眠呼吸暂停老年人以患者为中心的决策的患者决策辅助工具的疗效。

Efficacy of a patient decision aid for improving person-centered decision-making by older adults with obstructive sleep apnea.

机构信息

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.

出版信息

J Clin Sleep Med. 2021 Feb 1;17(2):121-128. doi: 10.5664/jcsm.8798.

DOI:10.5664/jcsm.8798

PMID:32955013

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7853212/

Abstract

STUDY OBJECTIVES

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.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov, Name: Improving Older Adults' Decision-Making for OSAT (eDecide2Rest); URL: https://clinicaltrials.gov/ct2/show/NCT03138993; Identifier: NCT03138993.

摘要

研究目的

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。

方法

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。

结果

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。