Brodney Suzanne, Sepucha Karen, Chang Yuchiao, Moulton Ben, Barry Michael J
Informed Medical Decisions Program, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Health Decision Sciences Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
JB JS Open Access. 2022 Mar 24;7(1). doi: 10.2106/JBJS.OA.21.00149. eCollection 2022 Jan-Mar.
Decision aids (DAs) are utilized to ensure that patients are informed and involved in the decision-making process. Although DAs improve decision quality, other aspects of the decision-making process, such as trust and regret, are seldom measured. The objective of the present study was to determine whether patients given a DA prior to orthopaedic surgery had greater trust and lower regret at 6 months postoperatively.
Consecutive patients were identified who underwent a hip or knee replacement or spine surgery from October 2018 to January 2020 and were subsequently surveyed at 6 months postoperatively. Outcomes included the Trust in the Surgical Decision and Decision Regret Scales. The primary analysis compared scores of patients who reviewed at least some of the DA to those who had not received or reviewed it. A sensitivity analysis compared patients with a DA order who reported reviewing it to those who did not. Multivariable models analyzed whether DA exposure predicted trust or regret. An exploratory mediation analysis examined the direct and indirect effects of DA exposure, including through the Shared Decision Making Process score.
The response rate was 56% (700 of 1,253). In the primary analysis, the proportion of patients who reported complete trust was 50.9% among those with no DA review and 63.8% among those with DA review (adjusted odds ratio, 1.62; 95% confidence interval, 1.11 to 2.36). A nonsignificant effect was observed comparing a DA order (59.9%) versus no DA order (51.4%; adjusted odds ratio, 1.30; 95% confidence interval, 0.80 to 2.11). Regret was unrelated to DA exposure. In the mediation analysis, 19.3% (95% confidence interval, 3.1% to 35.4%) of the effect of DA review on trust could be attributed to increased shared decision making.
Patients who reviewed a DA prior to orthopaedic surgery reported higher trust in their surgeons.
Providing patients with a DA prior to orthopaedic surgery can improve trust in the surgeon. Improving trust between patients and surgeons may improve communication and help patients make better health decisions.
决策辅助工具（DAs）用于确保患者了解情况并参与决策过程。尽管决策辅助工具能提高决策质量，但决策过程的其他方面，如信任和遗憾感，却很少被衡量。本研究的目的是确定在骨科手术前使用决策辅助工具的患者在术后6个月时是否有更高的信任度和更低的遗憾感。
确定2018年10月至2020年1月期间接受髋关节或膝关节置换术或脊柱手术的连续患者，并在术后6个月对其进行调查。结果包括手术决策信任度和决策遗憾量表。主要分析比较了至少查看了部分决策辅助工具的患者与未接受或未查看该工具的患者的得分。敏感性分析比较了有决策辅助工具医嘱且报告查看了该工具的患者与未查看的患者。多变量模型分析了接触决策辅助工具是否能预测信任度或遗憾感。探索性中介分析研究了接触决策辅助工具的直接和间接影响，包括通过共同决策过程得分。
回复率为56%（1253人中的700人）。在主要分析中，未查看决策辅助工具的患者中报告完全信任的比例为50.9%，查看了决策辅助工具的患者中这一比例为63.8%（调整后的优势比为1.62；95%置信区间为1.11至2.36）。比较有决策辅助工具医嘱（59.9%）与无决策辅助工具医嘱（51.4%）时观察到无显著影响（调整后的优势比为1.30；95%置信区间为0.80至2.11）。遗憾感与接触决策辅助工具无关。在中介分析中，决策辅助工具查看对信任度影响的19.3%（95%置信区间为3.1%至35.4%）可归因于共同决策的增加。
在骨科手术前查看决策辅助工具的患者对其外科医生的信任度更高。
在骨科手术前为患者提供决策辅助工具可提高对医生的信任度。改善患者与医生之间的信任可能会改善沟通并帮助患者做出更好的健康决策。
