National Eczema Association, Novato, California.
Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland.
JAMA Dermatol. 2022 Aug 1;158(8):912-918. doi: 10.1001/jamadermatol.2022.2441.
Engaging in shared decision-making (SDM) can help patients understand and choose treatments according to their values and has been shown to improve patient satisfaction and adherence with treatment. It is well suited for conditions like eczema for which several medically appropriate treatment options exist. However, little is known about the use and experience of SDM in eczema.
To understand experiences, preferences, and expectations for SDM in eczema care settings from the patient and caregiver perspective.
DESIGN, SETTING, AND PARTICIPANTS: The National Eczema Association conducted an online survey in January 2021 among self-selected patients and caregivers. Inclusion criteria (US resident, patient with eczema or caregiver of a patient with eczema aged ≤17 years, respondent age ≥18 years) were met by 1313 of 1387 respondents (94.7%). Data analysis was performed from May 2021 to November 2021.
Outcomes were past SDM (using a 9-item SDM questionnaire [SDMQ9]; score ranges transformed to 0-100), present SDM (Control Preferences Scale), and future SDM (self-reported confidence and motivation to engage in SDM) behavior.
Among the 1313 respondents included in the study, most were female (1046 of 1313 [79.7%]) adult (1086 of 1313 [82.7%]) patients with a mean (SD) patient Recap of Atopic Eczema score of 11.7 (7.2), mean (SD) patient age of 39.5 (22.2) years, and mean (SD) SDMQ9 score of 65.1 (27.4). For present SDM, 479 of 966 (49.6%) reported "I prefer to make the final decision after seriously considering my doctor's opinion," and 655 of 955 (69.4%) reported being very or extremely confident to engage in SDM in the future. Those who reported feeling "very well informed" about the causes of eczema had a 14.7-point higher (95% CI, 9.2-20.2; P < .001, multiple linear regression) SDMQ9 score than those "not adequately informed" and were 3.4 times more likely (95% CI, 2.1-5.7; P < .001, multiple logistic regression) to be confident to engage in future SDM. Respondents reported that they would be motivated to engage in SDM if the clinician initiated SDM, valued input from the patient, and acknowledged that patients are experts on their own bodies or if a treatment is no longer working.
Results of this survey study suggest that a majority of patients with eczema and caregivers prefer a large role in decision-making for their care and that clinicians can initiate and facilitate SDM to improve patient satisfaction with care.
进行共同决策（SDM）可以帮助患者根据自身价值观了解并选择治疗方法，已证实这可提高患者满意度和治疗依从性。这种方法非常适合存在多种医学上合理治疗方案的疾病，例如湿疹。然而，我们对湿疹患者在 SDM 中的使用情况和体验知之甚少。
从患者和护理人员的角度了解湿疹护理环境中 SDM 的使用、经验和期望。
设计、地点和参与者：国家湿疹协会于 2021 年 1 月在网上对自行选择的患者和护理人员进行了调查。1387 名符合纳入标准（美国居民、年龄≤17 岁的湿疹患者或患者的护理人员、受访者年龄≥18 岁）的受访者中，有 1313 名（94.7%）完成了调查。数据分析于 2021 年 5 月至 2021 年 11 月进行。
结局包括过去 SDM（使用 9 项 SDM 问卷[SDMQ9]；得分范围转换为 0-100）、当前 SDM（控制偏好量表）和未来 SDM（自我报告的参与 SDM 的信心和动机）行为。
在纳入研究的 1313 名受访者中，大多数为女性（1313 名中的 1046 名[79.7%]）、成年患者（1313 名中的 1086 名[82.7%]），平均（SD）患者特应性皮炎评分 11.7（7.2）、平均（SD）患者年龄 39.5（22.2）岁、平均（SD）SDMQ9 评分 65.1（27.4）。在当前的 SDM 方面，966 名患者中的 479 名（49.6%）报告“我更愿意在认真考虑医生意见后做出最终决定”，655 名患者中的 955 名（69.4%）报告他们对未来参与 SDM 非常有信心或非常有信心。那些表示自己对湿疹病因“非常了解”的人比那些“了解不足”的人 SDMQ9 评分高 14.7 分（95% CI，9.2-20.2；P < .001，多元线性回归），并且有 3.4 倍的可能性（95% CI，2.1-5.7；P < .001，多元逻辑回归）对未来的 SDM 有信心。受访者表示，如果临床医生启动 SDM、重视患者的意见、承认患者是自己身体的专家或治疗不再有效，他们将有动力参与 SDM。
这项调查研究的结果表明，大多数湿疹患者和护理人员都希望在其护理决策中发挥更大的作用，临床医生可以启动并促进 SDM，以提高患者对护理的满意度。
