Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Liggins Institute, University of Auckland, Auckland, New Zealand.
Ann Behav Med. 2022 May 18;56(5):512-522. doi: 10.1093/abm/kaab082.
Involving patients in treatment decisions is commonplace in healthcare, and patients are frequently accompanied by a companion (support person). Companions are often actively involved in medical consultations, yet their impact on decisions to change medications is unknown.
This study examines the influence of companions on a patient's decision to transition from their bio-originator therapy to a biosimilar.
A parallel, two-arm randomized controlled trial was conducted with 79 patients taking a bio-originator for rheumatic diseases who regularly attend clinic with a companion. Patients were randomized to receive an explanation about a hypothetical transition to a biosimilar alone or with their companion. Patients reported willingness to transition, risk perceptions, difficulty understanding, social support, and completed the Decisional Conflict Scale and Satisfaction with Decision Scale.
Companions did not influence decisions to transition to biosimilars or cognitive and affective risk perceptions. Accompanied patients reported more difficulty understanding the explanation (p = .006, Cohen's d = .64) but thought it was more important to receive information with companions (p = .023, Cohen's d = -.52). Companions did not impact decision satisfaction or decisional conflict. Receiving emotional, but not practical support, was associated with less decisional conflict in accompanied patients (p = .038, r2 = 0.20).
The presence of companions does not seem to influence risk perceptions or decisions about transitioning to biosimilars. Companions, however, impact the patient's reporting of their ability to understand treatment explanations. Providers should check understanding in all patients but may need to provide additional time or educational resources to accompanied patients and companions.
Australian New Zealand Clinical Trial Registry: ACTRN12619001435178.
在医疗保健中，让患者参与治疗决策是很常见的做法，而且患者通常会有一个陪伴者（支持者）陪同。陪伴者经常积极参与医疗咨询，但他们对改变药物治疗决策的影响尚不清楚。
本研究旨在考察陪伴者对患者决定从生物原研药治疗转换为生物类似药的影响。
采用平行、双臂随机对照试验，纳入 79 名正在接受风湿性疾病生物原研药治疗且经常与陪伴者一起就诊的患者。患者被随机分为单独或与陪伴者一起接受关于假设转换为生物类似药的解释。患者报告了转换的意愿、风险感知、理解难度、社会支持，并完成了决策冲突量表和决策满意度量表。
陪伴者并未影响患者是否决定转换为生物类似药或认知和情感风险感知。有陪伴者的患者报告理解解释的难度更大（p =.006，Cohen's d =.64），但认为与陪伴者一起接受信息更重要（p =.023，Cohen's d = -.52）。陪伴者对决策满意度或决策冲突没有影响。仅接受情感支持而非实际支持与陪伴者患者的决策冲突减少有关（p =.038，r2 = 0.20）。
陪伴者的存在似乎并不影响患者对转换为生物类似药的风险感知或决策。然而，陪伴者会影响患者对治疗解释的理解能力的报告。所有患者都应检查理解情况，但可能需要为有陪伴者的患者和陪伴者提供额外的时间或教育资源。
澳大利亚新西兰临床试验注册中心：ACTRN12619001435178。
