Department of Neurosurgery and Spine Surgery, Member of ENDO-ERN, University Hospital Essen, Essen, Germany.
Institute for Medical Education, University of Duisburg-Essen, Essen, Germany.
Pituitary. 2024 Oct;27(5):545-554. doi: 10.1007/s11102-024-01460-6. Epub 2024 Sep 25.
A patient-centered approach to the management of acromegaly includes disease activity control, shared decision-making and identification of comorbidities. The Acromegaly Disease Activity Tool (ACRODAT) is intended to assist physicians in providing such holistic management. The present study investigated this claim using the simulated person (SP) approach.
We studied patient-doctor interaction via online video consultation in a randomized prospective study design with SPs trained to simulate a specific acromegaly profile. We analyzed the proportion of conversation time devoted to health content and the specific acromegaly and comorbidity relevant categories mentioned in the conversation. We collected physicians' feedback on the usefulness of ACRODAT, SPs subjective perception of the quality of the conversation and compared consultations with and without ACRODAT using a qualitative approach.
The sample (N = 30) consisted of endocrinologists treating patients with acromegaly in Germany. For SP-physician interactions (N = 60), the proportion of time spent on conversation content (e.g. IGF-I, quality of life) was distributed according to the focus of the patient profile. Comorbidities were less well identified than the need for a change in therapy. Only 18.3% of the SPs were actively asked to participate in the decision-making process. ACRODAT did not lead to any significant differences in the course of the discussion.
Shared decision-making was underrepresented in this SP-physician interaction in acromegaly management. Physicians adapted the content of the discussion to the SP's needs, but did not adequately address comorbidities. According to the analysis criteria used, ACRODAT did not contribute to a more holistic patient management in the present study.
以患者为中心的肢端肥大症管理方法包括疾病活动控制、共同决策和共病识别。肢端肥大症疾病活动工具（ACRODAT）旨在帮助医生进行这种整体管理。本研究使用模拟人（SP）方法对此进行了研究。
我们通过在线视频咨询进行了一项随机前瞻性研究设计，对接受过特定肢端肥大症模拟培训的 SP 进行了患者-医生互动研究。我们分析了用于健康内容的对话时间比例，以及对话中提到的特定肢端肥大症和共病相关类别。我们收集了医生对 ACRODAT 的有用性的反馈意见、SP 对对话质量的主观感知，并使用定性方法比较了有和没有 ACRODAT 的咨询。
该样本（N=30）由德国治疗肢端肥大症患者的内分泌科医生组成。对于 SP-医生的互动（N=60），用于对话内容（例如 IGF-I、生活质量）的时间比例根据患者的病情焦点分布。与治疗方案改变相比，共病的识别较差。只有 18.3%的 SP 被积极邀请参与决策过程。ACRODAT 并未导致讨论过程中的任何显著差异。
在这种肢端肥大症管理中的 SP-医生互动中，共同决策的代表性不足。医生根据 SP 的需求调整讨论内容，但没有充分解决共病问题。根据使用的分析标准，ACRODAT 在本研究中并未为更全面的患者管理做出贡献。
