Zhang Duo, Zheng Haoyang, Zheng Zhi, Pan Youmin, Zha Zhengbiao, Liu Juan, Zhu Lisi, Wu Qiansheng, Hu Kaili, Chen Zelin, Wang Xiaoxiao, Barnabo Nampoukime Kan-Paatib, Zhou Yanrong
Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China.
School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China.
Rev Cardiovasc Med. 2023 Aug 24;24(8):244. doi: 10.31083/j.rcm2408244. eCollection 2023 Aug.
Complex surgical plans and consideration of risks and benefits often cause decisional conflicts for decision-makers in aortic dissection (AD) surgery, resulting in decision delay. Shared decision-making (SDM) improves decision readiness and reduces decisional conflicts. The purpose of this study was to investigate the impact of SDM on decision quality in AD.
One hundred and sixty AD decision-makers were divided into two groups: control (n = 80) and intervention (n = 80). The surgical plan for the intervention group was determined using patient decision aids. The primary outcome was decisional conflict. Secondary outcomes included decision preparation, decision satisfaction, surgical method, postoperative complications, actual participation role, and duration of consultation. The data were analyzed with SPSS 26.0 (IBM Corp., Chicago, IL, USA). 0.05 was considered statistically significant.
The decisional conflict score was significantly lower in the intervention group than in the control group ( 0.001). The decision preparation and decision satisfaction scores in the intervention group were significantly higher than those in the control group ( 0.001). There were more SDM decision-makers in the intervention group (16 [20%] vs. 42 [52.50%]). There was no statistical significance in the choice of surgical, postoperative complications, duration of consultation, and hospital and post-operative intensive care unit stay time ( = 0.267, = 0.130, = 0.070, = 0.397, = 0.421, respectively). Income, education level, and residence were the influencing factors of decision-making conflict.
SDM can reduce decisional conflict, improve decision preparation and satisfaction, and help decision-makers actively participate in the medical management of patients with AD without affecting the medical outcome.
复杂的手术方案以及对风险和益处的考量常常给主动脉夹层（AD）手术的决策者带来决策冲突，导致决策延迟。共同决策（SDM）可提高决策准备度并减少决策冲突。本研究旨在探讨SDM对AD决策质量的影响。
160名AD决策者被分为两组：对照组（n = 80）和干预组（n = 80）。使用患者决策辅助工具确定干预组的手术方案。主要结局是决策冲突。次要结局包括决策准备、决策满意度、手术方式、术后并发症、实际参与角色以及咨询时长。数据采用SPSS 26.0（美国伊利诺伊州芝加哥市IBM公司）进行分析。P < 0.05被认为具有统计学意义。
干预组的决策冲突得分显著低于对照组（P < 0.001）。干预组的决策准备和决策满意度得分显著高于对照组（P < 0.001）。干预组中采用SDM的决策者更多（16例[20%]对42例[52.50%]）。在手术选择、术后并发症、咨询时长以及住院和术后重症监护病房停留时间方面无统计学意义（分别为P = 0.267、P = 0.130、P = 0.070、P = 0.397、P = 0.421）。收入、教育水平和居住地是决策冲突的影响因素。
SDM可减少决策冲突，提高决策准备度和满意度，并帮助决策者积极参与AD患者的医疗管理，且不影响医疗结局。
