Trobaugh Jennifer, Fuqua Wayne, Folkert Kyra, Khalil Sarah, Shebrain Saad, Munene Gitonga
From the Department of Psychology, Behavioral Medicine Laboratory, Western Michigan University.
Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine.
Ann Surg Open. 2022 Aug 17;3(3):e196. doi: 10.1097/AS9.0000000000000196. eCollection 2022 Sep.
The objective of this study is to determine the factors influencing pancreatic surgery patients' perceptions of the shared decision-making process (SDM).
Decision-making in pancreatic surgery is complicated by the risk of morbidity and mortality and risk of early recurrence of disease. Improvement in SDM has the potential to improve the receipt of goal- and value-concordant care.
This cross-sectional survey included patients who underwent pancreatic surgery. The following components were studied in relation to SDM: modified satisfaction with decision scale (SWD), modified decisional regret scale (DRS), quality of physician and patient interaction, and the impact of quality of life (FACT-Hep). Correlations were computed using Pearson's correlation score and a regression model.
The survey completion rate was 72.2% (of 40/55) and the majority (72.5%) of patients underwent pancreaticoduodenectomy. There were significant positive relationships between the SDM measure and (DRS, SWD; = 0.70, < 0.001) and responses to questions regarding how well the patient's actual recovery matched their expectations before treatment ( = 0.62, < 0.001). The quality of the physician-patient relationship correlated with how well recovery matched expectations ( = 0.53, = 0.002). SDM measure scores were significant predictors of the decision evaluation measure ((adj) = 0.48, < 0.001), FACT-Hep ((adj) = 0.15, < 0.001), and recovery expectations measure ((adj) = 0.37, < 0.001).
Improved SDM in pancreatic surgery is associated with more realistic recovery expectations, decreased decisional regret, and improved quality of life.
本研究的目的是确定影响胰腺手术患者对共同决策过程（SDM）认知的因素。
胰腺手术中的决策因发病和死亡风险以及疾病早期复发风险而变得复杂。SDM的改善有可能提高目标和价值一致的护理的接受度。
这项横断面调查纳入了接受胰腺手术的患者。研究了以下与SDM相关的因素：改良的决策满意度量表（SWD）、改良的决策后悔量表（DRS）、医患互动质量以及生活质量的影响（FACT-Hep）。使用Pearson相关系数和回归模型计算相关性。
调查完成率为72.2%（40/55），大多数患者（72.5%）接受了胰十二指肠切除术。SDM测量值与（DRS、SWD；r = 0.70，P < 0.001）以及患者实际恢复情况与治疗前预期的匹配程度的问题回答之间存在显著正相关（r = 0.62，P < 0.001）。医患关系质量与恢复与预期的匹配程度相关（r = 0.53，P = 0.002）。SDM测量得分是决策评估测量值（调整后R² = 0.48，P < 0.001）、FACT-Hep（调整后R² = 0.15，P < 0.001）和恢复预期测量值（调整后R² = 0.37，P < 0.001）的显著预测因素。
胰腺手术中SDM的改善与更现实的恢复预期、减少的决策后悔以及生活质量的提高相关。
