使用EPOS 2020标准评估慢性鼻-鼻窦炎疾病控制的医生评估因素以及纳入患者疾病控制观点的重要性。
Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control.
作者信息
Sedaghat Ahmad R, Caradonna David S, Chandra Rakesh K, Franzese Christine, Gray Stacey T, Halderman Ashleigh A, Hopkins Claire, Kuan Edward C, Lee Jivianne T, McCoul Edward D, O'Brien Erin K, Pletcher Steven D, Pynnonen Melissa A, Wang Eric W, Wise Sarah K, Woodworth Bradford A, Yao William C, Phillips Katie M
机构信息
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Int Forum Allergy Rhinol. 2023 Nov;13(11):2004-2017. doi: 10.1002/alr.23168. Epub 2023 May 12.
BACKGROUND
We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient-reported CRS control).
METHODS
Fifteen rhinologists were provided with real-world data from 200 CRS patients. Participating rhinologists first classified patients' CRS control as "controlled," "partly controlled," and "uncontrolled" using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient-reported CRS control. They then classified patients' CRS control without knowledge of patient-reported CRS control. Interrater reliability and agreement of rhinologist-assessed CRS control with patient-reported CRS control and EPOS guidelines were determined.
RESULTS
CRS control classification with and without knowledge of patient-reported CRS control was highly consistent across rhinologists (κ = 0.758). Rhinologist-assessed CRS control agreed with patient-reported CRS control significantly better when rhinologists had knowledge of patient-reported CRS control (κ = 0.736 vs. κ = 0.554, p < 0.001). Patient-reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists' assessment of CRS control. Rhinologists' CRS control assessments weakly agreed with EPOS CRS control guidelines with (κ = 0.529) and without (κ = 0.538) patient-reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases.
CONCLUSIONS
This study directly demonstrates the importance of patient-reported CRS control as a dominant influence on rhinologists' CRS control assessment. Knowledge of patient-reported CRS control may better align rhinologists' CRS control assessments and treatment decisions with patients' perspectives.
背景
我们确定了与鼻科医生评估慢性鼻-鼻窦炎（CRS）控制情况相关的CRS表现，重点关注患者的观点（患者报告的CRS控制情况）。
方法
为15名鼻科医生提供了来自200例CRS患者的真实世界数据。参与研究的鼻科医生首先使用反映《欧洲鼻窦炎和鼻息肉立场文件》（EPOS）CRS控制标准的7种CRS表现（鼻塞、流涕、嗅觉减退、面部疼痛/压痛、睡眠障碍、过去6个月内使用全身用抗生素/皮质类固醇以及鼻内镜检查结果）和患者报告的CRS控制情况，将患者的CRS控制情况分为“控制良好”“部分控制”和“未控制”。然后，他们在不知道患者报告的CRS控制情况的前提下对患者的CRS控制情况进行分类。确定了鼻科医生评估的CRS控制情况与患者报告的CRS控制情况以及EPOS指南之间的评分者间信度和一致性。
结果
在鼻科医生中，了解和不了解患者报告的CRS控制情况时的CRS控制分类高度一致（κ = 0.758）。当鼻科医生了解患者报告的CRS控制情况时，鼻科医生评估的CRS控制情况与患者报告的CRS控制情况的一致性明显更好（κ = 0.736对κ = 0.554，p < 0.001）。患者报告的CRS控制情况、鼻塞、流涕和内镜检查结果与鼻科医生对CRS控制情况的评估相关性最强。鼻科医生对CRS控制情况的评估与EPOS CRS控制指南的一致性较弱，无论是否了解患者报告的CRS控制情况（κ = 0.529和κ = 0.538）。在近50%的病例中，鼻科医生将CRS分类为比EPOS指南控制得更好。
结论
本研究直接证明了患者报告的CRS控制情况作为对鼻科医生CRS控制评估的主要影响因素的重要性。了解患者报告的CRS控制情况可能会使鼻科医生的CRS控制评估和治疗决策与患者的观点更好地保持一致。
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