Turja Tuuli, Rosenlund Milla, Kuusisto Hanna
Faculty of Social Sciences, Tampere University, Tampere, Finland.
Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
Patient Prefer Adherence. 2024 Apr 11;18:821-826. doi: 10.2147/PPA.S454661. eCollection 2024.
In this short report contributing to the literature on treatment and vaccination adherence, nonadherence was examined from the perspective of decision-making (DM) practice in healthcare. The objective of this study was to survey the rationalities given for treatment nonadherence and their association with DM practice.
The Ottawa decision Support Framework was used as a theoretical background for the study. Multiple choice and open-text responses indicating nonadherence were drawn from vignette survey data. The results have been analyzed and reported as descriptive statistics and findings of data-driven content analysis. The number of observatory units was 1032 in the within-subject study design.
DM practice was predominantly associated with nonadherence to vaccination, whereas nonadherence to treatment was consistently associated with attitudinal reasons independent of DM practice. Nonadherence to vaccination was most often rationalized by prior negative experiences in simple DM scenarios. After other DM practices, nonadherence was rationalized by uncertainty and criticism about the benefits of the recommended vaccine. Mistrust toward healthcare providers stood out, first in treatment nonadherence generally and, second, in vaccination nonadherence after simple DM where the final decision was left to the patient.
In medical DM, adherence to treatment and vaccination may be achieved through a recognition of patients' previous healthcare encounters and potential trust-related concerns, which could pose a risk for nonadherence. To be able to observe these risks, patient engagement and mutual trust should be priorities in decision support in healthcare.
在这篇为治疗和疫苗接种依从性文献做出贡献的简短报告中，从医疗保健中的决策实践角度审视了不依从性。本研究的目的是调查治疗不依从的理由及其与决策实践的关联。
渥太华决策支持框架用作本研究的理论背景。表明不依从性的多项选择题和开放式文本回答取自情景调查数据。结果已作为描述性统计数据和数据驱动的内容分析结果进行了分析和报告。在受试者内研究设计中，观察单位数量为1032。
决策实践主要与疫苗接种不依从相关，而治疗不依从始终与态度原因相关，与决策实践无关。疫苗接种不依从最常因简单决策情景中的先前负面经历而合理化。在其他决策实践之后，不依从因对推荐疫苗益处的不确定性和批评而合理化。对医疗保健提供者的不信任尤为突出，首先在总体治疗不依从方面，其次在简单决策后由患者做出最终决定的疫苗接种不依从方面。
在医疗决策中，通过认识到患者以前的医疗经历以及潜在的信任相关问题，可能实现对治疗和疫苗接种的依从性，这些问题可能构成不依从的风险。为了能够观察到这些风险，患者参与和相互信任应成为医疗保健决策支持中的优先事项。
