Streeper Necole M, Sninsky Brian C, Penniston Kristina L, Best Sara L, Nakada Stephen Y
Department of Urology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
Urol Pract. 2016 Jul;3(4):289-295. doi: 10.1016/j.urpr.2015.07.011. Epub 2016 Apr 21.
Patients desire an active role in health care decisions. We evaluated whether a patient decision making aid is useful when considering surgical treatment for urolithiasis.
Patients with a history of urolithiasis were recruited for study. They were asked to consider a hypothetical case of an asymptomatic 10 mm proximal ureteral stone for which elective surgical intervention was recommended. Shock wave lithotripsy and ureteroscopy were presented as potential options. A patient decision making aid was developed to explain and compare the options. A urologist presented the information to the patients, once using the patient decision making aid and then without the aid. We assessed participant satisfaction with each format, and invited comments about the aid and its content, design and clarity.
Mean ± SD age of the 4 male and 10 female participants was 61 ± 9 years. Of the participants 86% found the patient decision making aid helpful but identified areas for improvement. Specifically, patients wanted more information on stent placement, stent discomfort, long-term effects and cost. Of the participants 79% reported that the aid improved their understanding of the treatment options compared to the session without the aid. While 8 of 14 participants preferred hearing surgeon recommendations, most still reported value in the patient decision making aid.
Patient decision making aids are increasingly used in the management of several diseases and they require patient input into development. In our study the aid improved patient self-reported understanding of surgical options for ureteral stone removal. Notably, most participants still preferred to make decisions based on the surgeon recommendation. Modification of the patient decision making aid based on patient suggestions will enhance its usefulness and applicability in the clinical setting.
患者希望在医疗决策中发挥积极作用。我们评估了在考虑对尿路结石进行手术治疗时，患者决策辅助工具是否有用。
招募有尿路结石病史的患者进行研究。要求他们考虑一个假设案例，即一名无症状的10毫米近端输尿管结石患者，建议进行择期手术干预。介绍了冲击波碎石术和输尿管镜检查作为潜在的选择。开发了一个患者决策辅助工具来解释和比较这些选择。一名泌尿科医生向患者介绍信息，一次使用患者决策辅助工具，一次不使用。我们评估了参与者对每种形式的满意度，并邀请他们对辅助工具及其内容、设计和清晰度发表意见。
4名男性和10名女性参与者的平均年龄±标准差为61±9岁。86%的参与者认为患者决策辅助工具很有帮助，但指出了需要改进的地方。具体而言，患者希望获得更多关于支架置入、支架不适、长期影响和费用的信息。79%的参与者报告说，与没有辅助工具的环节相比，该辅助工具提高了他们对治疗选择的理解。虽然14名参与者中有8人更喜欢听取外科医生的建议，但大多数人仍然认为患者决策辅助工具有价值。
患者决策辅助工具在多种疾病的管理中越来越多地被使用，并且需要患者参与其开发。在我们的研究中，该辅助工具提高了患者自我报告的对输尿管结石手术切除选择的理解。值得注意的是，大多数参与者仍然更喜欢根据外科医生的建议做出决定。根据患者建议修改患者决策辅助工具将提高其在临床环境中的有用性和适用性。
