急性心肌梗死住院患者的共同决策：一项随机试验
Shared Decision-Making for Patients Hospitalized with Acute Myocardial Infarction: A Randomized Trial.
作者信息
Branda Megan E, Kunneman Marleen, Meza-Contreras Alejandra I, Shah Nilay D, Hess Erik P, LeBlanc Annie, Linderbaum Jane A, Nelson Danika M, Mc Donah Margaret R, Sanvick Carrie, Van Houten Holly K, Coylewright Megan, Dick Sara R, Ting Henry H, Montori Victor M
机构信息
Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
出版信息
Patient Prefer Adherence. 2022 Jun 1;16:1395-1404. doi: 10.2147/PPA.S363528. eCollection 2022.
OBJECTIVE
Adherence to guideline-recommended medications after acute myocardial infarction (AMI) is suboptimal. Patient fidelity to treatment regimens may be related to their knowledge of the risk of death following AMI, the pros and cons of medications, and to their involvement in treatment decisions. Shared decision-making may improve both patients' knowledge and involvement in treatment decisions.
METHODS
In a pilot trial, patients hospitalized with AMI were randomized to the use of the conversation tool or to usual care. includes a pictogram of the patient's estimated risk of mortality at 6 months with and without guideline-recommended medications, ie, aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors. Primary outcomes were patient knowledge and conflict with the decision made assessed via post-encounter surveys. Secondary outcomes were patient involvement in the decision-making process (observer-based OPTION12 scale) and 6-month medication adherence.
RESULTS
Patient knowledge of the expected survival benefit from taking medications was significantly higher (62% vs 16%, <0.0001) in the group (n = 53) compared to the usual care group (n = 53). Both groups reported similarly low levels of conflict with the decision to start the medications (13 (SD 24.2) vs 16 (SD 22) out of 100; =0.16). The extent to which clinicians in the group involved their patients in the decision-making process was high (OPTION12 score 53 out of 100, SD 12). Medication adherence at 6-months was relatively high in both groups and not different between groups.
CONCLUSION
The conversation tool improved patients' knowledge of their estimated risk of short-term mortality after an AMI and the pros and cons of treatments to reduce this risk. The effect on patient fidelity to recommended medications of using this SDM tool and of SDM in general should be tested in larger trials enrolling patients at high risk for nonadherence.
TRIAL REGISTRATION NUMBER
NCT00888537.
目的
急性心肌梗死（AMI）后对指南推荐药物的依从性欠佳。患者对治疗方案的忠诚度可能与其对AMI后死亡风险的了解、药物的利弊以及参与治疗决策的程度有关。共同决策可能会提高患者对治疗决策的了解和参与度。
方法
在一项试点试验中，将因AMI住院的患者随机分为使用沟通工具组或常规治疗组。沟通工具包括一张患者在使用和不使用指南推荐药物（即阿司匹林、他汀类药物、β受体阻滞剂和血管紧张素转换酶抑制剂）情况下6个月估计死亡风险的象形图。主要结局是通过会诊后调查评估的患者知识以及与所做决策的冲突情况。次要结局是患者参与决策过程的程度（基于观察者的OPTION12量表）和6个月的药物依从性。
结果
与常规治疗组（n = 53）相比，沟通工具组（n = 53）中患者对服用药物预期生存益处的知晓率显著更高（62% 对16%，<0.0001）。两组报告的开始用药决策冲突水平同样较低（100分制中分别为13分（标准差24.2）对16分（标准差22）；P = 0.16）。沟通工具组的临床医生让患者参与决策过程的程度较高（OPTION12评分为100分中的53分，标准差12）。两组6个月时的药物依从性相对较高，且组间无差异。
结论
沟通工具提高了患者对AMI后短期死亡估计风险以及降低该风险治疗措施利弊的认识。应在纳入高不依从风险患者的更大规模试验中测试使用该共同决策工具以及一般共同决策对患者对推荐药物忠诚度的影响。
试验注册号
NCT00888537。
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