使用决策冲突规模评估静脉血栓栓塞预防共享决策干预 (DASH-TOP):一种混合方法研究
Montserrat León-García1,2,3, Brittany Humphries4, Pablo Roca Morales5,6
1Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. mleong@santpau.cat.
BMC medical informatics and decision making
|November 6, 2023
概括
像DASH-TOP这样的共享决策 (SDM) 干预措施可以减少怀孕期间的决策冲突. 决策分析组件最有效地提高了决策质量,尽管临床实施需要更多的研究.
科学领域:
- 产科和妇科 产科和妇科
- 医疗保健服务研究 医疗服务研究
- 决策科学 决策科学 决策科学
背景情况:
- 怀孕期间的静脉血栓塞栓症 (VTE) 是孕产妇死亡的一个重要原因.
- 低分子量肝素 (LMWH) 是预防静脉瘤的标准,但存在挑战.
- 建议在医疗保健中对偏好敏感的选择进行共享决策 (SDM) 干预.
研究的目的:
- 评估参与者对DASH-TOP SDM干预组件的看法.
- 通过使用决策冲突量表 (DCS) 评估SDM干预组件和决策冲突之间的关系.
主要方法:
- 采用了融合,并行和混合方法的设计.
- 22名医疗保健专业人员参与,分为三组,接受不同数量的SDM干预组件.
- 定量分析使用了DCS子尺度的非参数测试;定性分析涉及决策冲突领域的内容分析.
主要成果:
- 干预组件的增加与决策冲突的减少和决策质量的提高相关,尽管在统计学上并不显著.
- 决策分析建议提高决策效率,但面临实施挑战.
- 在所有组中都观察到很高的决策冲突,特别是在不确定性子级别上,由于信息确定性和药物有效性的感知.
结论:
- DASH-TOP干预有效地减少了决策冲突,决策分析是最有影响力的组成部分.
- 需要进一步的实施研究,以优化SDM干预在临床实践中的交付.
- 解决基于证据的信息和感知治疗效果的不确定性对于改善妊娠期间VTE预防的SDM至关重要.
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