Barradell Amy C, Singh Sally J, Houchen-Wolloff Linzy, Robertson Noelle, Bekker Hilary L
Dept of Respiratory Sciences, University of Leicester, Leicester, UK.
Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, UK.
ERJ Open Res. 2022 Jun 6;8(2). doi: 10.1183/23120541.00645-2021. eCollection 2022 Apr.
Despite the variety of pulmonary rehabilitation programmes for patients living with COPD, uptake remains low. To improve this, it is recommended that health professionals engage patients in informed decisions about pulmonary rehabilitation. Shared decision-making (SDM) facilitates informed and value-based decision-making between patients and health professionals. This protocol describes the development and evaluation of a complex SDM intervention for patients living with COPD, who are referred for pulmonary rehabilitation, and their pulmonary rehabilitation health professional.
We are developing a complex SDM intervention involving a patient decision aid (PtDA) and a decision coaching workshop. Prior to patient recruitment, pulmonary rehabilitation health professionals will attend the workshop. Upon referral to pulmonary rehabilitation, patients will receive the PtDA to support their decision-making prior to and during their pulmonary rehabilitation assessment with a health professional. The intervention will be evaluated in a one-arm exploratory study to investigate its feasibility and acceptability for patients and health professionals, with an integrated fidelity assessment. The primary outcome is recruitment feasibility, data collection feasibility and intervention fidelity. Secondary outcomes include routine pulmonary rehabilitation data, decisional conflict, patient activation, intervention attendance/attrition and patient and pulmonary rehabilitation health professional experience of the intervention. Quantitative outcomes will be evaluated using the most appropriate statistical test, dependent on the sample distribution. Qualitative outcomes will be evaluated using reflexive thematic analysis. Fidelity will be assessed using the Observer OPTION 5 scale.
This intervention will provide structure for an informed and values-based decision-making consultation between a patient with COPD and a pulmonary rehabilitation health professional with the potential for optimising pulmonary rehabilitation decision-making.
尽管针对慢性阻塞性肺疾病（COPD）患者有多种肺康复方案，但采用率仍然很低。为改善这一情况，建议医疗专业人员让患者参与有关肺康复的明智决策。共同决策（SDM）有助于患者和医疗专业人员之间做出明智且基于价值观的决策。本方案描述了一种针对被转诊接受肺康复的COPD患者及其肺康复医疗专业人员的复杂SDM干预措施的开发与评估。
我们正在开发一种复杂的SDM干预措施，包括患者决策辅助工具（PtDA）和决策指导工作坊。在招募患者之前，肺康复医疗专业人员将参加该工作坊。在被转诊接受肺康复时，患者将在与医疗专业人员进行肺康复评估之前和期间收到PtDA，以支持他们的决策。该干预措施将在一项单臂探索性研究中进行评估，以调查其对患者和医疗专业人员的可行性和可接受性，并进行综合的保真度评估。主要结局是招募可行性、数据收集可行性和干预保真度。次要结局包括常规肺康复数据、决策冲突、患者激活度、干预参与率/流失率以及患者和肺康复医疗专业人员对干预措施的体验。将根据样本分布使用最合适的统计检验来评估定量结局。将使用反思性主题分析来评估定性结局。将使用观察者OPTION 5量表评估保真度。
该干预措施将为COPD患者与肺康复医疗专业人员之间基于明智和价值观的决策咨询提供框架，有可能优化肺康复决策。
