健康素养、焦虑和教育对老年人共同决策和决策冲突的影响，以及患者参与的中介作用：一项视频观察研究。

The influence of health literacy, anxiety and education on shared decision making and decisional conflict in older adults, and the mediating role of patient participation: A video observational study.

机构信息

Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands.

Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.

出版信息

Patient Educ Couns. 2024 Jul;124:108274. doi: 10.1016/j.pec.2024.108274. Epub 2024 Mar 22.

DOI:10.1016/j.pec.2024.108274

PMID:38547640

Abstract

OBJECTIVE

To explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict.

METHODS

In a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data.

RESULTS

The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p < .001) was significantly associated with participation in the SDM process. Education (β = -2.43, p = .05) and anxiety (β = -.26, p = .058) had a marginally significant direct effect on the patients' perceived level of SDM. Education (β = 12.12, p = .002), health literacy (β = -.70, p = .005) and anxiety (β = 1.19, p = .004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM.

CONCLUSION

Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict.

PRACTICE IMPLICATIONS

Tailoring SDM communication to health literacy levels is important for high quality SDM.

摘要

目的

探讨患有多种慢性疾病（MCC）的老年人的个人特征与感知共享决策（SDM）和决策冲突之间的关系。

方法

在一项视频观察研究（N=213）中，收集了个人特征数据。主要结果是感知到的 SDM 水平和决策冲突。中介变量是参与 SDM 过程。采用两步混合效应多元线性回归和中介分析对数据进行分析。

结果

患者的平均年龄为 77.3 岁，56.3%为女性。健康素养（β.01，p<.001）与参与 SDM 过程显著相关。教育（β=-2.43，p=.05）和焦虑（β=-.26，p=.058）对患者感知的 SDM 水平有直接的边际影响。教育（β=12.12，p=.002）、健康素养（β=-.70，p=.005）和焦虑（β=1.19，p=.004）对决策冲突有直接影响。健康素养对决策冲突的影响通过参与 SDM 进行中介。