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复发性扁桃体炎决策辅助工具的试点项目

Piloting of a Decision Aid for Recurrent Tonsillitis.

作者信息

Hill Callum, Ah-See Kim, Moffat Helen

机构信息

The University of Aberdeen, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.

Ear, Nose and Throat Department, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.

出版信息

Clin Otolaryngol. 2025 May;50(3):500-506. doi: 10.1111/coa.14278. Epub 2025 Jan 16.

DOI:10.1111/coa.14278
PMID:39821535
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11975154/
Abstract

OBJECTIVE

Currently, there is no adult-specific decision aid (DA) to support decision-making regarding recurrent tonsillitis. This study intends to address this gap by piloting a prototype DA.

DESIGN

Randomised clinical trial.

SETTING

Single centre trial at a tertiary otolaryngology department.

PARTICIPANTS

Forty-three patients were randomised to either the DA or Treatment as Usual (TAU) group.

MAIN OUTCOME MEASURES

Primary objective: To measure how patients rate the quality of their decision-making experience at the time of the decision and at follow-up (SURE scale).

SECONDARY OBJECTIVE

The level of decisional satisfaction at the time of the decision and follow-up, as well as to explore the numbers of people opting for surgery for each study condition (Shared tool and patient feedback).

RESULTS

Quality: This study demonstrates no statistically significant difference in how patients rate the quality of their treatment decision between DA and TAU, both at baseline (p = 0.553) and follow-up (p = 0.062). Satisfaction: This study showed a statistically significant level of decisional satisfaction at the time the decision was made for Qu2 of the Shared tool (U = 113, p = 0.026). No other significant difference was found between participants who received the DA and TAU.

CONCLUSION

The DA is an acceptable and useful tool that could be incorporated into the pathway for recurrent tonsillitis, helping to eliminate physician implicit bias. However, preliminary qualitative evidence from this pilot study does not suggest that including the DA improves the quality of decision-making.

TRIAL REGISTRATION

IRAS ID - 230 362.

摘要

目的

目前,尚无专门针对成人的决策辅助工具(DA)来支持有关复发性扁桃体炎的决策制定。本研究旨在通过试点一个DA原型来填补这一空白。

设计

随机临床试验。

设置

在一家三级耳鼻喉科进行的单中心试验。

参与者

43名患者被随机分为DA组或常规治疗(TAU)组。

主要结局指标

主要目标:衡量患者在决策时和随访时对其决策体验质量的评分(SURE量表)。

次要目标

决策时和随访时的决策满意度水平,以及探讨每种研究条件下选择手术的人数(共享工具和患者反馈)。

结果

质量:本研究表明,在基线时(p = 0.553)和随访时(p = 0.062),患者对DA组和TAU组治疗决策质量的评分在统计学上无显著差异。满意度:本研究显示,在使用共享工具的Qu2进行决策时,决策满意度具有统计学意义(U = 113,p = 0.026)。在接受DA和TAU的参与者之间未发现其他显著差异。

结论

DA是一种可接受且有用的工具,可纳入复发性扁桃体炎的诊疗流程,有助于消除医生的隐性偏见。然而,这项初步试点研究的定性证据并不表明使用DA能提高决策质量。

试验注册

IRAS编号 - 230 362。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61bf/11975154/1903be43b077/COA-50-500-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61bf/11975154/3231ac7e8f8f/COA-50-500-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61bf/11975154/1903be43b077/COA-50-500-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61bf/11975154/3231ac7e8f8f/COA-50-500-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61bf/11975154/1903be43b077/COA-50-500-g002.jpg

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本文引用的文献

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Tonsillectomy compared with conservative management in patients over 16 years with recurrent sore throat: the NATTINA RCT and economic evaluation.扁桃体切除术与保守治疗对 16 岁以上复发性咽痛患者的比较:NATTINA RCT 及经济学评价。
Health Technol Assess. 2023 Dec;27(31):1-195. doi: 10.3310/YKUR3660.
2
Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management.英国的扁桃体炎、扁桃体切除术和深部颈间隙感染:制定手术和非手术治疗新指南的理由。
Ann R Coll Surg Engl. 2021 Mar;103(3):208-217. doi: 10.1308/rcsann.2020.7030.
3
Shared decision making and support for self-management: a rationale for change.
共同决策与自我管理支持:变革的基本原理
Future Hosp J. 2016 Jun;3(2):117-120. doi: 10.7861/futurehosp.3-2-117.
4
A 20-year observational cohort of a 5 million patient population-Tonsillectomy rates in the context of two national policy changes.一项针对 500 万患者人群的 20 年观察性队列研究——在两项国家政策变化背景下的扁桃体切除术率。
Clin Otolaryngol. 2019 Jan;44(1):7-13. doi: 10.1111/coa.13233. Epub 2018 Oct 25.
5
Informed consent-It's more than a signature on a piece of paper.知情同意——它远不止是在一张纸上签名。
Am J Surg. 2017 Dec;214(6):993-997. doi: 10.1016/j.amjsurg.2017.09.015. Epub 2017 Sep 20.
6
Decision aids for people facing health treatment or screening decisions.为面临医疗治疗或筛查决策的人们提供的决策辅助工具。
Cochrane Database Syst Rev. 2017 Apr 12;4(4):CD001431. doi: 10.1002/14651858.CD001431.pub5.
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Stakeholders' views of recurrent sore throat, tonsillitis and their management: a qualitative interview study for the NAtional Trial of Tonsillectomy IN Adults (NATTINA Part 1).利益相关者对复发性咽痛、扁桃体炎及其管理的看法:成人扁桃体切除术全国试验(NATTINA第1部分)的定性访谈研究
Clin Otolaryngol. 2017 Apr;42(2):301-306. doi: 10.1111/coa.12720. Epub 2016 Aug 23.
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Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument.对医疗服务提供者让患者参与决策程度的评估:使用OPTION工具的研究的系统评价
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