基于多学科编码的同行专业知识,为腹腔大动脉动脉瘤破裂患者开发多学科决策支持工具:一个离散选择实验
Lotte F Hijkoop1, Martijn L Dijkstra1, Barbara L van Leeuwen2
1Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
概括
一个新的决策支持工具 (DSI) 帮助专家决定破裂腹腔大动脉瘤 (rAAA) 治疗. 患者的脆弱性,预期寿命和治疗愿望是这些紧急医疗决策的关键因素.
科学领域:
- 医疗决策的制定 医疗决策的制定
- 血管外科 血管外科
- 老年病的医生 老年病的医生
背景情况:
- 破裂腹腔大动脉动脉瘤 (rAAA) 的治疗决策是复杂的,时间敏感的,并且经常以不完整的信息做出决定.
- 在紧急情况下,多学科咨询往往是不可用的.
研究的目的:
- 开发一个决策支持工具 (DSI),预测专家对rAAA治疗的决定.
- 将患者特异性因素如脆弱性,预期寿命和治疗偏好纳入DSI.
主要方法:
- 一个离散选择实验被用来开发DSI.
- 一个多学科专家小组确定了标准,并评估了虚构的患者场景.
- 根据专家的共识,每个标准都被赋予相对重要性 (RI) 权重.
主要成果:
- 确定了11个标准,影响了rAAA治疗决定.
- 最重要的标准是心脏负担 (15% RI),年龄 (13% RI),预期寿命 (13% RI),临床脆弱度量表 (12% RI) 和肺负担 (12% RI).
- 根据患者的标准,DSI预测了那些会选择手术的专家的百分比.
结论:
- 使用多学科专家的共识,为急性rAAA治疗计划制定了临床DSI.
- 患者的脆弱性,预计寿命和患者对手术的愿望被确定为关键的,往往被低估的决策因素.
- DSI可以在复杂,紧急的rAAA病例中支持一致的决策,并有助于识别适合息治疗的患者.
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