Carrissa Abigail Roxas Ma, Jimeno Cecilia, Palileo-Villanueva Lia, Macalalad-Josue Anna Angelica, Sandoval Mark Anthony, Fernandez Jose Alberto
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines - Philippine General Hospital, Philippines.
College of Medicine, University of the Philippines Manila, Philippines.
J ASEAN Fed Endocr Soc. 2020;35(1):93-101. doi: 10.15605/jafes.035.01.15. Epub 2020 May 23.
Guidelines for osteoporosis have provided recommendations on when to offer pharmacologic management for postmenopausal women, but do not specify which "best" medication to start. The choice of therapy depends on the efficacy, safety/tolerability of the drug and the patient's profile and preferences. Patient decision aids (PtDA) are tools designed to facilitate shared decision-making (SDM) between the patient and health care provider for conditions where there are several available options, and the "best" choice is unclear. We aimed to develop a culturally acceptable patient decision aid on the treatment of osteoporosis among Filipino postmenopausal women at risk of osteoporotic fractures.
A qualitative approach and an iterative process was employed in this study following the guidance of the International Patient Decision Aid Standards (IPDAS). Phase 1 (Needs Assessment) involved interviews with 8 physicians who are involved in the care of women with osteoporosis and focus group discussions with 19 postmenopausal women with osteoporosis who have received treatment. Phase 2 (PtDA Development) involved a systematic review of evidence and development of an initial prototype through several iterations with an expert panel. The final prototype was pilot tested in actual clinical encounters (Phase 3).
The final PtDA consists of 6 laminated flashcards, which illustrate the different considerations that are important to patients when selecting an anti-osteoporosis treatment (efficacy, method, frequency of administration, side effects and cost), and a fracture worksheet to illustrate individualized effects of the treatments on the patient's fracture risk. These are accompanied by a clinician guide on how to use the PtDA during consultations, which includes information on non-pharmacologic management of osteoporosis. The PtDA was acceptable to physicians and patients.
With the integration of decisional needs assessment, clinical expertise, user preference and iterative revision testing, we were able to develop a culturally adapted PtDA on the treatment of osteoporosis among Filipino postmenopausal woman at risk of osteoporotic fractures for use during clinical encounters.
骨质疏松症指南已就何时为绝经后女性提供药物治疗提出了建议，但未明确应首先选用哪种“最佳”药物。治疗方案的选择取决于药物的疗效、安全性/耐受性以及患者的情况和偏好。患者决策辅助工具（PtDA）是旨在促进患者与医疗保健提供者之间就存在多种可用选项且“最佳”选择不明确的疾病进行共同决策（SDM）的工具。我们旨在为有骨质疏松性骨折风险的菲律宾绝经后女性开发一种在文化上可接受的骨质疏松症治疗患者决策辅助工具。
本研究采用定性方法和迭代过程，遵循国际患者决策辅助工具标准（IPDAS）的指导。第1阶段（需求评估）包括对8名参与骨质疏松症女性护理的医生进行访谈，以及与19名接受过治疗的绝经后骨质疏松症女性进行焦点小组讨论。第2阶段（PtDA开发）包括对证据进行系统回顾，并通过与专家小组的多次迭代开发初始原型。最终原型在实际临床会诊中进行了试点测试（第3阶段）。
最终的PtDA由6张分层抽认卡组成，展示了患者在选择抗骨质疏松治疗时重要的不同考虑因素（疗效、方法、给药频率、副作用和成本），以及一张骨折工作表，以说明治疗对患者骨折风险的个体化影响。这些还配有一份临床医生指南，介绍如何在会诊期间使用PtDA，其中包括骨质疏松症非药物管理的信息。PtDA得到了医生和患者的认可。
通过整合决策需求评估、临床专业知识、用户偏好和迭代修订测试，我们能够为有骨质疏松性骨折风险的菲律宾绝经后女性开发一种经过文化调整的骨质疏松症治疗PtDA，用于临床会诊。
