Goldstein Eliana C, Neuman Mark D, Haar Viktoria Vonder, Li Aaron C, Guerra-Londono Carlos E, Elwyn Glyn, Deiner Stacie G, Hussain Adnan, Sappenfield Joshua W, Edwards Christopher J, Ayad Sabry, Baraldi James H, Whatley Karah, Politi Mary C
Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Medicine, Division of Geriatric Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Br J Anaesth. 2025 Apr;134(4):1058-1067. doi: 10.1016/j.bja.2025.01.012. Epub 2025 Feb 11.
Shared decision making is rarely used in anaesthesia consultations. Because either spinal or general anaesthesia can be appropriate for many patients undergoing surgery to repair a hip fracture, this is an appropriate context to implement and test shared decision making and associated resources for anaesthesia decisions. Conversation aids can facilitate shared decision making between clinicians, patients, and caregivers about treatment choices.
We conducted semi-structured qualitative interviews at seven sites from April to September 2024 to prepare for implementation of a conversation aid about anaesthesia choices for hip fracture surgery. Interviews elicited feedback on shared decision making and a proposed conversation aid comparing spinal and general anaesthesia.
We interviewed 12 clinicians and 12 patients and caregivers. The analysis identified four themes, which we mapped to the Practical, Robust Implementation and Sustainability Model. We found (1) broad support for shared decision making in anaesthesia choices before hip fracture surgery, although it is not typically incorporated in current practice; (2) barriers to shared decision making, including institutional culture, preexisting clinician assumptions about patient preferences, and time; (3) features of a resource (i.e. the conversation aid) that can help overcome these barriers; and (4) the importance of engaging in shared decision making with an appropriate clinician. Suggestions from interviews were incorporated into the conversation aid.
Reasonable shared decision-making strategies such as conversation aids were seen by most participants as helpful to support shared decision making about anaesthesia options for hip fracture surgery. Engaging end users at the local level can address key implementation barriers.
共同决策在麻醉会诊中很少使用。由于脊髓麻醉或全身麻醉对许多接受髋部骨折修复手术的患者都可能适用，因此这是实施和测试共同决策及相关麻醉决策资源的合适背景。沟通辅助工具可以促进临床医生、患者及其护理人员之间就治疗选择进行共同决策。
2024年4月至9月，我们在七个地点进行了半结构化定性访谈，为实施关于髋部骨折手术麻醉选择的沟通辅助工具做准备。访谈收集了关于共同决策以及比较脊髓麻醉和全身麻醉的拟议沟通辅助工具的反馈。
我们采访了12名临床医生以及12名患者和护理人员。分析确定了四个主题，并将其映射到实用、稳健实施和可持续性模型。我们发现：（1）尽管目前的实践中通常没有纳入，但在髋部骨折手术前的麻醉选择中，共同决策得到了广泛支持；（2）共同决策存在障碍，包括机构文化、临床医生对患者偏好的既有假设以及时间；（3）一种资源（即沟通辅助工具）的特征可以帮助克服这些障碍；（4）与合适的临床医生进行共同决策的重要性。访谈中的建议被纳入了沟通辅助工具。
大多数参与者认为，诸如沟通辅助工具之类合理的共同决策策略有助于支持关于髋部骨折手术麻醉选择的共同决策。让地方层面的最终用户参与可以解决关键的实施障碍。
