老年人结肠直肠癌查中的共享决策:对集群随机临床试验的二次分析
Karen R Sepucha1,2, Yuchiao Chang1,2, K D Valentine1,2
1Division of General Internal Medicine, Massachusetts General Hospital, Boston.
JAMA network open
|August 23, 2024
概括
对医生进行的共享决策 (SDM) 培训并没有增加老年人结直肠癌 (CRC) 查整体一致性. 然而,它可能有利于那些有强烈意图进行首选查或与初级保健医生 (PCP) 进行更长时间讨论的患者.
科学领域:
- 老年学是一门学科.
- 公共卫生 公共卫生
- 临床医学 临床医学
背景情况:
- 共同决策 (SDM) 对老年人做结直肠癌 (CRC) 查决策至关重要.
- 确定何时停止对老年人群进行CRC查存在困难.
研究的目的:
- 评估医生SDM培训和电子提醒对患者偏好的CRC查方法和老年人整体查率的影响.
- 评估一个干预措施的有效性,结合SDM培训和预警提醒,而不是仅仅提醒.
主要方法:
- 涉及36个初级保健实践的PRIMED集群随机临床试验的二次分析.
- 干预组:医生接受SDM培训和预诊提醒;比较组:医生仅接受提醒.
- 包括76-85岁的患者,逾期进行CRC查. 通过调查和电子健康记录评估12个月后的结果.
主要成果:
- 大约一半的患者接受了他们首选的CRC查方法 (50.9%的干预与46.2%的比较).
- 两组之间一致性或CRC查率没有显著的总体差异.
- 干预表明,对于有强烈意图接受首选查的患者 (AOR 1.79) 和较长的PCP讨论 (>5分钟,AOR 3.27) 的患者,一致性更高.
结论:
- 医生SDM培训没有显著改善老年人总体偏好一致的CRC查.
- 该干预表明,对特定的患者子组有潜在的益处,表明需要量身定制的方法.
- 进一步的研究应侧重于完善临床决策支持工具和PCP的SDM培训,以加强符合偏好的CRC查决策.
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