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在CKD的医疗保健访问中共享决策:患者的决策角色偏好和经验
Dorinde E M van der Horst1, Nieneke Hofstra2, Cornelia F van Uden-Kraan2
1Department of Internal Medicine, St. Antonius Hospital, Nieuwegein; Santeon, Utrecht, Leiden University Medical Centre, Leiden; Department of Internal Medicine, Leiden University Medical Centre, Leiden.
概括
患有慢性病 (CKD) 的患者往往更喜欢共享决策 (SDM) 对于各种治疗选择,但他们的经验往往与这些偏好不一致. 在医疗保健访问期间观察到的SDM行为特别低,这表明患者的需求尚未得到满足.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗保健管理的管理
- 以患者为中心的护理
背景情况:
- 慢性病 (CKD) 的共同决策 (SDM) 研究主要集中在替代治疗上.
- 需要了解患者对其他CKD相关决策的偏好和经验,以及他们与医疗保健专业人员的互动.
研究的目的:
- 探索患者对慢性病决定的认知,超越置换疗法.
- 调查患者对这些决定的偏好和经验.
- 分析在CKD护理中患者与提供者互动期间如何做出决策.
主要方法:
- 在荷兰两家医院对122名慢性病患者进行了横截面研究.
- 用控制偏好尺度评估患者对决策角色的偏好.
- 通过使用验证仪器 (4SDM,MI TCI) 的音频记录来测量观察到的SDM和激励面试.
主要成果:
- 患者经常报告计划,药物改变和生活方式修改的决定.
- 有相当数量的患者 (116/357) 喜欢分享决策角色,但151/357的决策与他们经验中的角色不匹配.
- 观察到的SDM水平很低 (中位数为4/118个决定),很少使用激励性采访技术.
结论:
- 在CKD护理中,首选的,经验丰富的和观察到的SDM之间存在差异.
- 虽然许多CKD患者希望共享决策,但当前的医疗互动很少表现出SDM行为.
- 在CKD中,人们对共享决策的偏好往往没有得到满足,这凸显了以患者为中心的护理方面的差距.
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