新患者就诊后脱垂治疗相关决策冲突。
Prolapse Treatment-Related Decisional Conflict After New Patient Visits.
机构信息
From the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida.
出版信息
Urogynecology (Phila). 2024 Nov 1;30(11):919-928. doi: 10.1097/SPV.0000000000001570. Epub 2024 Sep 27.
IMPORTANCE
Patients with pelvic organ prolapse are often tasked with deciding between treatments. Decisional conflict is a measure of factors that go into effective decision making.
OBJECTIVE
This study aimed to compare prolapse treatment-related decisional conflict reported by underrepresented patients (URPs) to non-URPs after new patient visits.
STUDY DESIGN
A multicenter cohort study of new patients counseled regarding management of prolapse from July 2021 to December 2022 was performed. Participants completed the Decisional Conflict Scale (DCS), a validated measure of modifiable factors in decision making. Higher scores indicate feeling less comfortable with decisions. Race and ethnicity were viewed as social constructs. A URP was defined as self-identification with a non-White race or Hispanic ethnicity. Alpha was set at 0.05, power 80%, to detect an effect size of 0.4 between mean DCS scores.
RESULTS
A total of 207 participants (103 URPs, 49.8%), with a mean age of 63.4 ± 11.9 years and mean body mass index of 29.7 ± 6.9 (calculated as weight in kilograms divided by height in meters squared), completed the study. Much of the URP group self-identified as Hispanic (50/103, 48.5%) and/or Black (39/103, 37.9%), and 30 of 103 (29.1%) had an interpreter at their visit. A greater proportion of non-URPs had a prior hysterectomy (16.1% difference; P = 0.017) and prolapse surgery (18/204, 10.5% difference; P = 0.020). A greater proportion of URPs had hypertension (23.6% difference; P = <0.001). There were no differences in the other pelvic floor disorders, prolapse stage, or treatments selected (all P > 0.05). The mean DCS scores were not different between groups (URP, 12.9 ± 12.3 vs non-URP, 11.6 ± 14.9; P = 0.31). Household income, education, and insurance were not associated with DCS scores (all P > 0.05).
CONCLUSIONS
Decisional Conflict Scale scores were not significantly different between groups. Possible differences between subgroups warrant further investigation.
重要性
患有盆腔器官脱垂的患者通常需要在治疗方法之间做出选择。决策冲突是衡量有效决策因素的一种方法。
目的
本研究旨在比较新就诊患者中代表性不足患者（URP）与非 URP 患者报告的与脱垂治疗相关的决策冲突。
研究设计
这是一项多中心队列研究，对 2021 年 7 月至 2022 年 12 月期间接受脱垂管理咨询的新患者进行了研究。参与者完成了决策冲突量表（DCS），这是一种衡量决策中可改变因素的有效方法。得分越高表示对决策的舒适度越低。种族和民族被视为社会建构。URP 的定义是自我认同为非白人种族或西班牙裔。α 值设定为 0.05，功效为 80%，以检测平均 DCS 得分之间 0.4 的效应量。
结果
共有 207 名参与者（103 名 URP，49.8%）完成了研究，平均年龄为 63.4±11.9 岁，平均体重指数为 29.7±6.9（计算方法为体重公斤数除以身高米数的平方）。URP 组大部分自我认同为西班牙裔（50/103，48.5%）和/或非裔（39/103，37.9%），103 名参与者中有 30 名（29.1%）在就诊时使用了翻译。非 URP 组中有更多的人接受过子宫切除术（16.1%的差异；P=0.017）和脱垂手术（204 人中 18 人，10.5%的差异；P=0.020）。URP 组中高血压的比例更高（23.6%的差异；P<0.001）。其他盆底疾病、脱垂阶段或选择的治疗方法没有差异（均 P>0.05）。两组的平均 DCS 评分无差异（URP，12.9±12.3 vs 非 URP，11.6±14.9；P=0.31）。家庭收入、教育程度和保险状况与 DCS 评分无关（均 P>0.05）。
结论
两组间 DCS 评分无显著差异。亚组之间的可能差异需要进一步研究。
Zotero 插件