对下一代置换疗法进行患者偏好权衡
Leslie Wilson1, Anne F Gress2, Lynda Frassetto3
1Department of Pharmacy, University of California, San Francisco, San Francisco, California.
Clinical journal of the American Society of Nephrology : CJASN
|October 24, 2023
概括
患有功能衰竭的患者优先考虑移动性,愿意接受一些风险,如感染或死亡,以获得脱离透析中心的自由. 这突出了新的KRT设备开发的关键权衡.
科学领域:
- 科和生物医学工程
- 医疗设备创新 医疗设备创新
- 以患者为中心的护理
背景情况:
- 下一代可植入和可穿戴的脏替代疗法 (KRTs) 承诺增强透析患者的流动性和治疗频率.
- 了解患者的风险-益处看法对于指导这些创新医疗器械的设计和开发至关重要.
- 与潜在的KRT进步相比,目前的中心内血液透析限制了患者的流动性和生活方式.
研究的目的:
- 确定影响患者在不同KRT方式中的选择的关键风险和益处考虑因素.
- 量化患者愿意在KRT中换取特定风险以获得所需的好处的意愿.
- 为医疗器械开发人员提供有关患者对下一代透析技术的偏好信息.
主要方法:
- 开发了一种基于选择的联合离散选择仪器,并给498名患有功能衰竭的患者使用.
- 评估了9个风险 (如严重感染,在5年内死亡) 和益处 (如流动性,饮食限制) 的属性.
- 混合效应回归建模分析了患者治疗决策中的属性重要性和权衡.
主要成果:
- 所有评估的属性,除了随访要求,显著影响了患者的KRT选择.
- 患者对死亡 (β=-2.22) 和严重感染 (β=-1.46) 的风险增加表现出强烈的厌恶.
- 患者愿意将1%的感染风险和0.5%的死亡风险换成完全的流动性和无需中心内血液透析.
结论:
- 尽管厌恶死亡和感染等风险,功能衰竭患者优先考虑移动.
- 患者表示愿意接受与KRT相关的某些风险,以实现更大的生活方式自由.
- 这些发现强调了移动性作为高级KRT患者治疗选择的关键驱动因素的重要性.
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