医生培训和患者教育对内科学门诊护理决策讨论的影响。
The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic.
机构信息
Department of Internal Medicine and Dermatology, University Medical Centre Utrecht, 85500, 3508 GA Utrecht, Utrecht, The Netherlands.
Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Trans 10, 3512 JK, Utrecht, Utrecht, the Netherlands.
出版信息
BMC Health Serv Res. 2022 Dec 22;22(1):1569. doi: 10.1186/s12913-022-08901-7.
BACKGROUND
Care decision discussions are intended to align treatment with the patient's wishes, goals and values. To overcome the numerous barriers to such discussions, physicians as well as patients need tailored support. We evaluate the effect of a physicians' training and a conversation aid for patients about care decisions on patient and physician outcomes.
METHODS
At the internal medicine outpatient clinic of the University Medical Centre Utrecht, a 1:1 randomized, parallel-group study (patient conversation aid) was combined with a pre-post intervention (physicians' training) design. Primary outcome was patient satisfaction, secondary outcomes were patient-doctor relationship, shared-decision-making, doctor preparedness and patient appreciation of the conversation aid.
RESULTS
Between October 2018 and February 2020 11 physicians (36% residents, 73% female) and 185 patients (median age 58 years (interquartile range (IQR) 50-68), 60% male) participated. Only 28% of the patients reported a care decision discussion during the consultation. We found no effect of the interventions on patient satisfaction (effect sizes -0.14 (95% confidence interval (CI) -0.56-0.27) for conversation aid; 0.04 (95% CI -0.40-0.48) for physician's training), nor on the patient-doctor relationship or shared-decision-making. However, physicians felt more prepared to discuss care decisions after training (median 3 (IQR 1-4) vs 1 (IQR 0-3), p = 0.015). Patients assessed the conversation aid informative and gave an overall mark of median 7 (IQR 7-8).
CONCLUSIONS
First steps towards fruitful discussions about care decisions were made: patients considered the conversation aid informative and physicians felt better prepared to discuss care decisions after training. The low number of care decision conversations patients reported shows exactly how important it is to focus on interventions that facilitate these discussions, for both the patient and physician. Further work needs to be done to establish the best way to empower patients and physicians.
TRIAL REGISTRATION
Dutch trial register, trial 6998 (NTR 7188), registered 04/05/2018, https://www.trialregister.nl/trial/6998 .
背景
护理决策讨论旨在使治疗与患者的意愿、目标和价值观保持一致。为了克服此类讨论中存在的众多障碍，医生和患者都需要有针对性的支持。我们评估了医生培训和患者护理决策对话辅助工具对患者和医生结局的影响。
方法
在乌得勒支大学医学中心的内科门诊，我们采用了 1:1 随机平行组研究（患者对话辅助工具），并结合了干预前后的预试验（医生培训）设计。主要结局是患者满意度，次要结局是患者-医生关系、共同决策、医生准备情况和患者对对话辅助工具的评价。
结果
2018 年 10 月至 2020 年 2 月，共有 11 名医生（36%为住院医师，73%为女性）和 185 名患者（中位年龄 58 岁（四分位间距 50-68），60%为男性）参与了研究。只有 28%的患者在就诊时报告了护理决策讨论。我们发现干预措施对患者满意度没有影响（对话辅助工具的效应大小为-0.14（95%置信区间-0.56-0.27）；医生培训为 0.04（95%置信区间-0.40-0.48）），也没有对医患关系或共同决策产生影响。然而，医生在培训后感到更有准备讨论护理决策（中位数 3（四分位间距 1-4）比 1（四分位间距 0-3），p=0.015）。患者认为对话辅助工具提供了有用的信息，并给出了总体评分中位数为 7（四分位间距 7-8）。
结论
为开展富有成效的护理决策讨论迈出了第一步：患者认为对话辅助工具提供了有用的信息，医生在培训后感到更有准备讨论护理决策。患者报告的护理决策讨论次数较少，这恰恰表明关注促进这些讨论的干预措施对患者和医生都非常重要。需要进一步努力确定增强患者和医生能力的最佳方法。
试验注册
荷兰试验注册中心，试验号 6998（NTR 7188），注册于 2018 年 4 月 5 日，https://www.trialregister.nl/trial/6998。
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