支持在手术环境中有效的共享决策:为什么对高风险患者和临床医生来说,选择框架很重要?
Agata Ludwiczak1,2, Timothy J Stephens3, John Prowle3
1Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK.
概括
接受高风险手术的患者与医生对结果的期望不同,这影响了共享决策 (SDM). 框架非手术选择,以强调行动可以改善患者的代理和控制在医疗保健决策.
科学领域:
- 医疗决策的制定 医疗决策的制定
- 手术结果研究研究.
- 患者与医生的沟通 患者与医生的沟通
背景情况:
- 共享决策 (SDM) 对于高风险手术至关重要,但由于患者和临床医生的期望不同,可能会受到损害.
- 患者和医生之间感知到的术后结果的错误调整可能会阻碍有效的SDM.
研究的目的:
- 调查高风险手术患者和临床医生之间的期望错位的程度和影响.
- 探索视角调整干预措施在解决这种错误调整方面的有效性.
主要方法:
- 一个在线实验涉及普通参与者 (查尔森并发症指数≥4) 和外科医生/麻醉师.
- 参与者预测了假设的外科手术场景的短期和长期结果,首先从他们自己的角度,然后从另一组的角度.
- 使用双项通用线性混合模型分析了治疗选择 (手术与非手术).
主要成果:
- 观察到一个系统的错位:患者预计手术结果比医生更好.
- 与医生相比,患者预计长期功能恢复更大,并发症更少.
- 尽管失调,但这两组都表现出对手术治疗的强烈偏好.
结论:
- 将非手术选择视为被动 ("不做任何事情") 可能会影响决策.
- 为了增强SDM,应提出非手术治疗方法,以强调行动,代理和积极的变化.
- 改善患者主动性和控制是高风险手术中更好的医疗保健决策的关键.
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