Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain.
Patient Educ Couns. 2022 Dec;105(12):3459-3465. doi: 10.1016/j.pec.2022.08.014. Epub 2022 Aug 28.
To assess gender differences in the decision-making process for treatment of knee osteoarthritis (OA).
A secondary analysis of a randomized trial was conducted (n = 193). Knowledge of OA and total knee replacement (TKR), decisional conflict, satisfaction with the decision-making process, treatment preference and TKR uptake 6 months later were compared by gender. Multivariate regression models were developed to identify gender-specific predictors.
Women showed less knowledge (MD = -7.68, 95% CI: -13.9, -1.46, p = 0.016), reported less satisfaction (MD = -6.95, 95% CI: -11.7, -2.23, p = 0.004) and gave more importance to avoiding surgery (U = 2.09, p = 0.019). In women, more importance attributed to the time needed to relieve symptoms significantly reduced the odds of surgery (OR = 0.76, p = 0.016).
The provision of information and/or promotion of shared decision-making could be of lower quality in female patients, although other explanations such as differences in information needs or preference for involvement in decision-making cannot be ruled out with the current evidence. Given the study's limitations, especially regarding the sample size, further confirmation is needed.
A systematic, shared decision-making approach in consultation is needed to avoid potential gender-based biases.
评估膝关节骨关节炎（OA）治疗决策过程中的性别差异。
对一项随机试验进行了二次分析（n=193）。按性别比较了对 OA 和全膝关节置换术（TKR）的了解程度、决策冲突、对决策过程的满意度、治疗偏好以及 6 个月后的 TKR 接受率。采用多元回归模型确定性别特异性预测因素。
女性的知识水平较低（MD=-7.68，95%CI：-13.9，-1.46，p=0.016），报告的满意度较低（MD=-6.95，95%CI：-11.7，-2.23，p=0.004），更重视避免手术（U=2.09，p=0.019）。在女性中，对缓解症状所需时间的重视程度显著降低了手术的可能性（OR=0.76，p=0.016）。
尽管目前的证据不能排除信息需求或参与决策偏好的差异等其他解释，但女性患者获得的信息和/或促进共同决策的质量可能较低。鉴于该研究的局限性，特别是样本量的限制，还需要进一步证实。
需要在咨询中采用系统的、共同决策的方法，以避免潜在的基于性别的偏见。
