Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia.
Health Expect. 2024 Jun;27(3):e14111. doi: 10.1111/hex.14111.
Surgery can help patients with leg pain caused by sciatica recover faster, but by 12 months outcomes are similar to nonsurgical management. For many the decision to have surgery may require reflection, and patient decision aids are an evidence-based clinical tool that can help guide patients through this decision.
The aim of this study was to develop and refine a decision aid for patients with sciatica who are deciding whether to have surgery or 'wait and see' (i.e., try nonsurgical management first).
Semistructured interviews with think-aloud user-testing protocol.
Twenty clinicians and 20 patients with lived experience of low back pain or sciatica.
Items from Technology Acceptance Model, Preparation for Decision Making Scale and Decision Quality Instrument for Herniated Disc 2.0 (knowledge instrument).
The prototype integrated relevant research with working group perspectives, decision aid standards and health literacy guidelines. The research team refined the prototype through seven rounds of user-testing, which involved discussing user-testing feedback and implementing changes before progressing to the next round.
As a result of working group feedback, the decision aid was divided into sections: before, during and after a visit to the surgeon. Across all rounds of user-testing, clinicians rated the resource 5.9/7 (SD = 1.0) for perceived usefulness, and 6.0/7 for perceived ease of use (SD = 0.8). Patients reported the decision aid was easy to understand, on average correctly answering 3.4/5 knowledge questions (SD = 1.2) about surgery for sciatica. The grade reading score for the website was 9.0. Patients scored highly on preparation for decision-making (4.4/5, SD = 0.7), suggesting strong potential to empower patients. Interview feedback showed that patients and clinicians felt the decision aid would encourage question-asking and help patients reflect on personal values.
Clinicians found the decision aid acceptable, patients found it was easy to understand and both groups felt it would empower patients to actively engage in their care and come to an informed decision that aligned with personal values. Input from the working group and user-testing was crucial for ensuring that the decision aid met patient and clinician needs.
Patients and clinicians contributed to prototype development via the working group.
手术可以帮助坐骨神经痛患者更快地康复，但 12 个月后，手术和非手术治疗的结果相似。对于许多人来说，是否选择手术可能需要慎重考虑，而患者决策辅助工具是一种基于证据的临床工具，可以帮助患者做出决策。
本研究旨在为考虑是否进行手术（即先尝试非手术治疗）的坐骨神经痛患者开发和完善一种决策辅助工具。
半结构化访谈与出声思维用户测试协议。
20 名临床医生和 20 名有过腰痛或坐骨神经痛经历的患者。
技术接受模型、决策准备量表和椎间盘突出症决策质量工具 2.0（知识工具）的项目。
原型综合了相关研究、工作组观点、决策辅助工具标准和健康素养指南。研究团队通过七轮用户测试对原型进行了改进，包括讨论用户测试反馈和在进入下一轮之前实施更改。
根据工作组的反馈，决策辅助工具分为术前、术中和术后三部分。在所有轮次的用户测试中，临床医生对资源的有用性评分分别为 5.9/7（标准差=1.0），易用性评分为 6.0/7（标准差=0.8）。患者报告称，该决策辅助工具易于理解，平均正确回答 3.4/5 个关于坐骨神经痛手术的知识问题（标准差=1.2）。网站的阅读成绩为 9.0。患者在决策准备方面的得分很高（4.4/5，标准差=0.7），这表明该决策辅助工具具有很大的潜力，能够赋予患者权力。访谈反馈显示，患者和临床医生认为该决策辅助工具将鼓励提问，并帮助患者反思个人价值观。
临床医生认为该决策辅助工具可接受，患者认为该工具易于理解，并且患者和临床医生都认为该决策辅助工具将使患者能够积极参与他们的治疗并做出符合个人价值观的知情决策。工作组和用户测试的输入对于确保决策辅助工具满足患者和临床医生的需求至关重要。
患者和临床医生通过工作组为原型开发提供了意见。
