Naglie G, Silberfeld M, O'Rourke K, Fried B, Corber W, Bombardier C, Detsky A
Division of General Internal Medicine and Geriatric Medicine, Toronto Hospital, Ontario, Canada.
J Clin Epidemiol. 1993 Mar;46(3):221-30. doi: 10.1016/0895-4356(93)90069-d.
The objective of this study was to evaluate the clinical utility of a decisional aid for mental capacity assessments which was developed using a group judgment methodology. This was carried out by a randomized, controlled trial. The subjects comprised 64 University of Toronto psychiatry residents in postgraduate years 1 through 4. Residents were randomized to carry out mental capacity assessments on simulated cases with, or without, the use of the decisional aid. The main outcome measure was the extent of agreement between the mental capacity determinations of residents and those of experts. There was no difference between the intervention and control groups with respect to the overall mean level of agreement with experts (0.87 vs 0.86, p = 0.88; 95% confidence interval for the difference between the study groups, -0.07 to +0.08). A logistic regression analysis, which adjusted for imbalances between the groups, also revealed no difference between the groups in their agreement with experts. The mean time per competency assessment was significantly longer in the intervention group (19.1 vs 10.8 min; p < 0.001). It was concluded that the decisional aid did not improve the ability of the psychiatry residents to make mental capacity assessments on simulated cases. Despite relatively limited formal training, the psychiatry residents had a high level of agreement with experts.
本研究的目的是评估一种使用群体判断方法开发的用于精神能力评估的决策辅助工具的临床效用。这是通过一项随机对照试验来进行的。研究对象包括64名多伦多大学1至4年级的精神病学住院医师。住院医师被随机分配，在使用或不使用决策辅助工具的情况下，对模拟病例进行精神能力评估。主要结局指标是住院医师与专家在精神能力判定方面的一致程度。干预组和对照组在与专家的总体平均一致水平上没有差异（分别为0.87和0.86，p = 0.88；研究组间差异的95%置信区间为-0.07至+0.08）。一项针对组间不平衡进行调整的逻辑回归分析也显示，两组在与专家的一致性方面没有差异。干预组每次能力评估的平均时间显著更长（19.1分钟对10.8分钟；p < 0.001）。得出的结论是，该决策辅助工具并未提高精神病学住院医师对模拟病例进行精神能力评估的能力。尽管接受的正规培训相对有限，但精神病学住院医师与专家的一致程度较高。
