Barry M J, Fowler F J, Mulley A G, Henderson J V, Wennberg J E
Medical Practices Evaluation Center, Massachusetts General Hospital, Boston 02114, USA.
Med Care. 1995 Aug;33(8):771-82. doi: 10.1097/00005650-199508000-00003.
Patients often want considerable information about their conditions, and enhanced patient participation might reduce unwanted practice variation and improve medical decisions. The authors assessed how men with benign prostatic hyperplasia reacted to an education program designed to facilitate participation in decisionmaking, and how strongly ratings of their symptom state and the prospect of complications predicted their treatment choice. A prospective cohort study was conducted in three hospital-based urology practices: two in prepaid group practices, and one Veterans Administration clinic. Four hundred twenty-one men with symptomatic benign prostatic hyperplasia without prior prostatectomy or benign prostatic hyperplasia complications were enrolled, and 373 provided usable ratings. Subjects participated in an interactive videodisc-based shared decisionmaking program about benign prostatic hyperplasia and its treatment options, prostatectomy, and "watchful waiting." They rated the length, clarity, balance, and value of the program and were followed for 3 months to determine if they underwent surgery. Patients rated the program as generally clear, informative, and balanced. Across all three sites, 77% of patients were very positive and 16% were generally positive about the program's usefulness in making a treatment decision. Logistic models predicting choice of surgical treatment documented the independent importance of negative ratings of the current symptom state (odds ratio 7.0, 95% confidence interval 2.9-16.6), as well as the prospect of postoperative sexual dysfunction (odds ratio 0.20, 95% confidence interval 0.08-0.48) in decisionmaking. Patients rated the Shared Decisionmaking Program very positively and made decisions consistent with their assessed preferences. These results suggest that patients can be helped to participate in treatment decisions, and support a randomized trial of the Shared Decisionmaking Program.
患者通常希望了解大量有关自身病情的信息，而增强患者参与度可能会减少不必要的医疗差异并改善医疗决策。作者评估了良性前列腺增生男性对旨在促进参与决策的教育项目的反应，以及他们对症状状态的评分和并发症可能性对其治疗选择的预测强度。在三个医院泌尿外科开展了一项前瞻性队列研究：两个在预付费团体诊所，一个在退伍军人管理局诊所。招募了421名有症状的良性前列腺增生男性，他们之前未接受过前列腺切除术或患有良性前列腺增生并发症，其中373人提供了可用评分。受试者参与了一个基于交互式视频光盘的关于良性前列腺增生及其治疗选择、前列腺切除术和“观察等待”的共同决策项目。他们对该项目的时长、清晰度、平衡性和价值进行了评分，并随访3个月以确定他们是否接受了手术。患者对该项目的评价总体上是清晰、信息丰富且平衡的。在所有三个地点，77%的患者对该项目在做出治疗决策方面的有用性非常肯定，16%的患者总体上持肯定态度。预测手术治疗选择的逻辑模型证明了当前症状状态负面评分（优势比7.0，95%置信区间2.9 - 16.6）以及术后性功能障碍可能性（优势比0.20，95%置信区间0.08 - 0.48）在决策中的独立重要性。患者对共同决策项目评价非常积极，并做出了与其评估偏好一致的决策。这些结果表明，可以帮助患者参与治疗决策，并支持对共同决策项目进行随机试验。
