精神障碍患者的共享决策及其相关因素：一项横断面研究。
Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study.
机构信息
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B 104, Brumunddal, 2381, Norway.
Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.
出版信息
BMC Psychiatry. 2023 Oct 13;23(1):747. doi: 10.1186/s12888-023-05257-y.
BACKGROUND
Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence. The implementation of shared decision making remains limited for patients with psychotic disorders despite being recommended at policy level, being advocated as ethical right and wanted by the patient's. A barrier to implementation that is often mentioned is reduced decision-making capacity among patients. The challenges of implementing shared decision making highlights a need for more knowledge on shared decision making for these patients. Moreover, the association between patient-related characteristics and shared decision making is unclear, and further research have been suggested. More knowledge of factors associated with involvement in shared decision making can enhance understanding and help to empower patients in the decision-making process. The current study examined the extent of reported shared decision making among patients with a psychotic disorder in mental health care and factors associated with shared decision making.
METHODS
This study included 305 participants with a psychotic disorder from 39 clinical inpatient and outpatient sites across Norway. Shared decision making was assessed using the CollaboRATE survey. A linear mixed model was estimated to assess characteristics associated with shared decision making scores.
RESULTS
The CollaboRATE mean score was 6.3 (ranging from 0 to 9), the top score was 14.1% and increased global satisfaction with services was significantly associated with a higher level of shared decision making (regression coefficient 0.27, 95% confidence interval (0.23; 0.32), p < 0.001).
CONCLUSIONS
The low top score shows that few patients felt that they received the highest possible quality of shared decision making, indicating that many patients found room for improvement. This suggests that services for patients with psychotic disorders should be designed to give them a greater role in decision making. Shared decision making might play a key role in mental health care, ensuring that patients with psychotic disorders are satisfied with the services provided.
TRIAL REGISTRATION
NCT03271242, date of registration: 5 Sept. 2017.
背景
共同决策是一个患者和临床医生合作根据患者的偏好和最佳现有证据做出治疗选择的过程。尽管在政策层面上推荐、倡导为患者的道德权利，但对于精神障碍患者来说，共同决策的实施仍然有限。实施共同决策的一个经常被提及的障碍是患者决策能力的降低。实施共同决策所面临的挑战凸显了需要更多关于这些患者共同决策的知识。此外，患者相关特征与共同决策之间的关联尚不清楚，因此建议进一步研究。更多与参与共同决策相关的因素的知识可以增强理解并有助于在决策过程中赋予患者权力。本研究考察了精神卫生保健中精神障碍患者报告的共同决策程度以及与共同决策相关的因素。
方法
本研究纳入了来自挪威 39 个临床住院和门诊点的 305 名精神障碍患者。使用 CollaboRATE 调查评估共同决策。采用线性混合模型评估与共同决策评分相关的特征。
结果
CollaboRATE 平均得分为 6.3（范围为 0 至 9），最高得分为 14.1%，对服务的总体满意度显著与更高水平的共同决策相关（回归系数 0.27，95%置信区间（0.23；0.32），p < 0.001）。
结论
低的最高分表明，很少有患者认为他们得到了共同决策的最高质量，这表明许多患者还有改进的空间。这表明，针对精神障碍患者的服务应设计为让他们在决策中发挥更大的作用。共同决策可能在精神卫生保健中发挥关键作用，确保精神障碍患者对所提供的服务感到满意。
试验注册
NCT03271242，注册日期：2017 年 9 月 5 日。
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