在不确定的甲状腺结节的手术咨询期间共享决策.
Victoria Taylor1,2, Travis Pickett3, Brooke Turner4
1Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
概括
患有不确定的甲状腺结节 (ITNs) 的患者经历了决策冲突 (DC),尽管他们认为共享决策 (SDM) 的水平很高. 通过决策辅助工具加强SDM对于减少患者在ITN管理中的不确定性至关重要.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 不确定的甲状腺结节 (ITNs) 呈现多种管理选择,经常导致决策冲突 (DC) 和患者的不确定性.
- 共享决策 (SDM) 对于导航复杂的医疗选择至关重要,特别是在像ITNs这样的条件下.
研究的目的:
- 评估患者和医生参与ITN管理的SDM.
- 在ITN的背景下,研究SDM和患者感知到的DC之间的关系.
主要方法:
- 这是一项多机构,跨部门的研究,涉及ITN患者和耳鼻喉科医生之间的视频记录咨询.
- 利用验证的问卷 (SDM-Q-9,DCS,SDM-Q-Doc) 和MAPPIN的SDM仪器来从多个角度测量SDM和DC.
- 包括加拿大两个主要医院的77名患者和6名外科医生.
主要成果:
- 患者感知SDM的高 (平均值=94.38),而医生感知SDM的低 (平均值=83.21).
- 观察员确定SDM参与率对于患者,医生和患者-医生二元组是低的.
- 在患者感知到的SDM和DC之间发现了显著的负相关性 (r=-0.311,P=0.008),其中13.2%的患者报告了临床显著的DC.
结论:
- 尽管人们认为SDM很高,但ITN患者经历了重大决策冲突.
- 需要改进决策支持工具,以加强SDM并减轻ITN管理中的DC.
- 研究结果强调了以患者为中心的沟通和决策辅助工具对于优化ITN的护理途径的重要性.
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