多层面实施计划对乳腺癌护理中共同决策的影响。
Effect of a multilevel implementation programme on shared decision-making in breast cancer care.
机构信息
Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Dutch Association of Oncology Patient Organizations, Utrecht, the Netherlands.
出版信息
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zraa002.
BACKGROUND
Women with newly diagnosed breast cancer face multiple treatment options. Involving them in a shared decision-making (SDM) process is essential. The aim of this study was to evaluate whether a multilevel implementation programme enhanced the level of SDM behaviour of clinicians observed in consultations.
METHODS
This before-after study was conducted in six Dutch hospitals. Patients with breast cancer who were facing a decision on surgery or neoadjuvant systemic treatment between April 2016 and September 2017 were included, and provided informed consent. Audio recordings of consultations made before and after implementation were analysed using the five-item Observing Patient Involvement in Decision-Making (OPTION-5) instrument to assess whether clinicians adopted new behaviour needed for applying SDM. Patients scored their perceived level of SDM, using the nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Hospital, duration of the consultation(s), age, and number of consultations per patient that might influence OPTION-5 scores were investigated using linear regression analysis.
RESULTS
Consultations of 139 patients were audiotaped, including 80 before and 59 after implementation. Mean (s.d.) OPTION-5 scores, expressed on a 0-100 scale, increased from 38.3 (15.0) at baseline to 53.2 (14.8) 1 year after implementation (mean difference (MD) 14.9, 95 per cent c.i. 9.9 to 19.9). SDM-Q-9 scores of 105 patients (75.5 per cent) (72 before and 33 after implementation) were high and showed no significant changes (91.3 versus 87.6; MD -3.7, -9.3 to 1.9). The implementation programme had an association with OPTION-5 scores (β = 14.2, P < 0.001), hospital (β = 2.2, P = 0.002), and consultation time (β = 0.2, P < 0.001).
CONCLUSION
A multilevel implementation programme supporting SDM in breast cancer care increased the adoption of SDM behaviour of clinicians in consultations.
背景
新诊断出患有乳腺癌的女性面临着多种治疗选择。让她们参与到共同决策（SDM）过程中是至关重要的。本研究的目的是评估一个多层次实施计划是否能提高临床医生在咨询中观察到的 SDM 行为水平。
方法
本研究采用前后对照设计，在 6 家荷兰医院进行。2016 年 4 月至 2017 年 9 月期间，面临手术或新辅助全身治疗决策的乳腺癌患者纳入研究，并获得知情同意。使用五分量表观察患者参与决策（OPTION-5）工具分析咨询前后的音频记录，以评估临床医生是否采用了应用 SDM 所需的新行为。患者使用 9 分量表共享决策问卷（SDM-Q-9）对他们感知的 SDM 水平进行评分。使用线性回归分析调查可能影响 OPTION-5 评分的医院、咨询时间、年龄和每位患者的咨询次数。
结果
共对 139 名患者的咨询进行了录音，包括实施前 80 次和实施后 59 次。0-100 量表上的 OPTION-5 评分均值（标准差）从基线时的 38.3（15.0）增加到实施后 1 年时的 53.2（14.8）（平均差值（MD）14.9，95%可信区间 9.9 至 19.9）。105 名患者（75.5%）（实施前 72 名，实施后 33 名）的 SDM-Q-9 评分较高且无显著变化（91.3 比 87.6；MD -3.7，-9.3 至 1.9）。实施计划与 OPTION-5 评分（β=14.2，P<0.001）、医院（β=2.2，P=0.002）和咨询时间（β=0.2，P<0.001）有关。
结论
支持乳腺癌护理中 SDM 的多层次实施计划增加了临床医生在咨询中采用 SDM 行为的比例。
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