Hawkins Alexander T, Ueland Thomas, Aher Chetan, Geiger Timothy M, Spann Matthew D, Horst Sara N, Schafer Isabella V, Ye Fei, Fan Run, Sharp Kenneth W
Section of Colon and Rectal Surgery (Hawkins, Ueland, Geiger, Schafer), Vanderbilt University Medical Center, Nashville, TN.
From the Division of General Surgery (Aher, Spann, Sharp), Vanderbilt University Medical Center, Nashville, TN.
J Am Coll Surg. 2023 Apr 1;236(4):762-771. doi: 10.1097/XCS.0000000000000538. Epub 2023 Jan 19.
The coronavirus disease 2019 (COVID-19) pandemic has accelerated a shift toward virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesize that telemedicine visits are associated with lower quality of shared decision-making.
We performed a mixed-methods, prospective, observational cohort trial. All patients presenting for a first-time visit at general surgery clinics between May 2021 and June 2022 were included. Patients were categorized by type of visit: in-person vs telemedicine. The primary outcome was the level of shared decision-making as captured by top box scores of the CollaboRATE measure. Secondary outcomes included quality of shared decision-making as captured by the 9-item Shared Decision-Making Questionnaire and satisfaction with consultation survey. An adjusted analysis was performed accounting for potential confounders. A qualitative analysis of open-ended questions for both patients and practitioners was performed.
During a 13-month study period, 387 patients were enrolled, of which 301 (77.8%) underwent in-person visits and 86 (22.2%) underwent telemedicine visits. The groups were similar in age, sex, employment, education, and generic quality-of-life scores. In an adjusted analysis, a visit type of telemedicine was not associated with either the CollaboRATE top box score (odds ratio 1.27; 95% CI 0.74 to 2.20) or 9-item Shared Decision-Making Questionnaire (β -0.60; p = 0.76). Similarly, there was no difference in other outcomes. Themes from qualitative patient and surgeon responses included physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communication quality.
In this large, prospective study, there does not appear to be a difference in quality of shared decision making in patients undergoing in-person vs telemedicine appointments.
2019年冠状病毒病（COVID-19）大流行加速了向与外科医生进行虚拟远程医疗预约的转变。虽然这种医疗服务形式对患者和外科医生都有潜在益处，但这些互动的质量在很大程度上仍未得到研究。我们假设远程医疗就诊与较低的共同决策质量相关。
我们进行了一项混合方法、前瞻性观察性队列试验。纳入了2021年5月至2022年6月期间首次到普通外科门诊就诊的所有患者。患者按就诊类型分类：面对面就诊与远程医疗就诊。主要结局是通过CollaboRATE量表的顶级评分所反映的共同决策水平。次要结局包括通过9项共同决策问卷所反映的共同决策质量以及咨询满意度调查。进行了调整分析以考虑潜在的混杂因素。对患者和从业者的开放式问题进行了定性分析。
在为期13个月的研究期间，共纳入387例患者，其中301例（77.8%）进行了面对面就诊，86例（22.2%）进行了远程医疗就诊。两组在年龄、性别、就业、教育和一般生活质量评分方面相似。在调整分析中，远程医疗就诊类型与CollaboRATE顶级评分（优势比1.27；95%置信区间0.74至2.20）或9项共同决策问卷（β -0.60；p = 0.76）均无关。同样，其他结局也没有差异。患者和外科医生定性回复的主题包括身体在场、时间投入、就诊目的的适宜性、技术困难和沟通质量。
在这项大型前瞻性研究中，面对面就诊与远程医疗就诊的患者在共同决策质量上似乎没有差异。
