Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32 Karolinska University Hospital, Stockholm, S-14186, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, S-11883, Sweden.
BMC Emerg Med. 2024 Jul 15;24(1):118. doi: 10.1186/s12873-024-01037-3.
In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team - creating 'distributed teams'. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing. The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians' perceptions regarding shared decision-making differ between co-located and distributed emergency teams.
In an observational study with a randomized cross-over design, healthcare professionals (n = 51) participated in authentic teams (n = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations.
A significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (p = 0.02). In the PIC-ET tool category 'Sharing power', the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (p = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (p = 0.03).
Team behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.
在瑞典北部农村，远程医疗被用于改善医疗保健的可及性并提供以患者为中心的护理。在值班期间的急救中，视频会议系统用于将医生与团队的其他成员联系起来，从而创建“分布式团队”。患者参与是医疗保健专业人员的核心能力。关于分布式团队合作如何影响患者参与以及临床医生对共同决策的看法，这方面的知识尚不清楚。本研究旨在调查在集中式和分布式急救团队中，团队合作是否以及如何影响患者参与，以及临床医生对共同决策的看法是否存在差异。
采用观察性研究设计，参与者为 51 名医疗保健专业人员（n=51），他们参加了两个脚本模拟急救场景中的真实团队（n=17），每个场景都有一名标准化患者：一个是集中式团队，另一个是分布式团队。使用 PIC-ET 工具对团队表现进行录像和观察，由独立评估者对患者参与行为进行评分。参与者在各自的场景后单独填写了 Dyadic OPTION 问卷，以测量共同决策的感知。这两种工具的分数均转换为最高分数的百分比。使用线性混合效应回归模型比较两种设置下的观察数据，使用单向方差分析比较自我报告的问卷数据。参与者和观察者均未对分配情况进行盲法处理。
观察者评定的整体患者参与行为存在显著差异，集中式团队的平均得分 51.1（±11.5）%，分布式团队的平均得分 44.7（±8.6）%（p=0.02）。在 PIC-ET 工具的“共享权力”类别中，集中式团队的得分从 14.4（±12.4）%降至分布式团队的 2（±4.4）%（p=0.001）。集中式团队自我评估的共同决策得分为 60.5%（±14.4），分布式团队的得分为 55.8%（±15.1）（p=0.03）。
在分布式团队中，发现促进患者参与的团队行为减少，尤其是在与患者共享权力方面。这一发现也反映在医疗保健专业人员的自我评估中。这项研究强调了患者与分布式急救团队之间权力不对称增加的风险，可为进一步的研究、教育和质量改进提供依据。
