Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL.
Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL.
Am J Obstet Gynecol. 2024 Jan;230(1):81.e1-81.e9. doi: 10.1016/j.ajog.2023.06.024. Epub 2023 Jun 15.
Studies have shown up to a 40% discordance between patients' preferred roles in decision-making before and their perceived roles after their visit. This can negatively affect patients' experiences; interventions to minimize this discordance may significantly improve patient satisfaction.
We aimed to determine whether physicians' awareness of patients' preferred involvement in decision-making before their initial urogynecology visit affects patients' perceived level of involvement after their visit.
This randomized controlled trial enrolled adult English-speaking women presenting for their initial visit at an academic urogynecology clinic from June 2022 to September 2022. Before the visit, participants completed the Control Preference Scale to determine the patient's preferred level of decision-making: active, collaborative, or passive. The participants were randomized to either the physician team being aware of their decision-making preference before the visit or usual care. The participants were blinded. After the visit, participants again completed a Control Preference Scale and the Patient Global Impression of Improvement, CollaboRATE, patient satisfaction, and health literacy questionnaires. Fisher exact, logistic regression, and generalized estimating equations were used. Based on a 21% difference in preferred and perceived discordance, we calculated the sample size to be 50 patients in each arm to achieve 80% power.
Women (n=100) with a mean age of 52.9 years (standard deviation=15.8) participated in the study. Most participants identified as White (73%) and non-Hispanic (70%). Before the visit, most women preferred an active role (61%) and few preferred a passive role (7%). There was no significant difference between the 2 cohorts in the discordance between their pre- and post-Control Preference Scale responses (27% vs 37%; P=.39) or whether their symptoms were much better or very much better following the visit (18% vs 37%; P=.06). However, when asked whether they were completely satisfied with the visit, those assigned to the physician awareness cohort reported higher satisfaction than those in the treatment as usual cohort (100% vs 90%; P=.03).
Although there was no significant decrease in discordance between the patient's desired and perceived level of decision-making following physician awareness, it had a significant effect on patient satisfaction. All patients whose physicians were aware of their preferences reported complete satisfaction with their visit. Although patient-centered care does not always entail meeting all of the patients' expectations, the mere understanding of their preferences in decision-making can lead to complete patient satisfaction.
研究表明，患者在就诊前对决策角色的偏好与就诊后感知到的角色之间存在高达 40%的差异。这可能会对患者的体验产生负面影响；减少这种差异的干预措施可能会显著提高患者的满意度。
我们旨在确定医生在初次就诊前对患者参与决策的偏好的了解是否会影响患者就诊后的感知参与度。
这是一项随机对照试验，招募了 2022 年 6 月至 9 月在学术泌尿科诊所就诊的成年英语女性患者。就诊前，参与者完成了控制偏好量表，以确定患者的决策偏好：主动、协作或被动。参与者被随机分配到医生团队在就诊前了解他们的决策偏好或常规护理。参与者被设盲。就诊后，参与者再次完成控制偏好量表、患者整体改善印象、CollaboRATE、患者满意度和健康素养问卷。使用 Fisher 确切检验、逻辑回归和广义估计方程。基于偏好和感知差异 21%的差异，我们计算出每组 50 名患者的样本量，以实现 80%的效力。
100 名平均年龄为 52.9 岁（标准差=15.8）的女性参与了这项研究。大多数参与者为白人（73%）和非西班牙裔（70%）。就诊前，大多数女性更喜欢主动参与（61%），很少有人选择被动参与（7%）。在就诊前和就诊后控制偏好量表的回答之间，两组之间的差异没有统计学意义（27%比 37%；P=.39），或者她们的症状在就诊后是否有很大改善或非常改善（18%比 37%；P=.06）。然而，当被问及她们是否对就诊完全满意时，那些被分配到医生意识组的患者报告的满意度高于那些接受常规治疗的患者（100%比 90%；P=.03）。
尽管在医生意识到患者的偏好后，患者期望的决策水平与实际感知到的水平之间的差异没有显著降低，但这对患者的满意度有显著影响。所有医生了解其偏好的患者都报告对就诊完全满意。尽管以患者为中心的护理并不总是需要满足所有患者的期望，但仅仅了解他们在决策中的偏好就可以使患者完全满意。
