Exploring patient involvement in decision making for vascular procedures
Exploring patient involvement in decision making for vascular procedures
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DOI：
10.1016/j.jvs.2015.04.443
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发表时间：
2015-10-01
影响因子：
4.3
通讯作者：
Burke, Gregory L.
中科院分区：
文献类型：
--
作者：
Corriere, Matthew A.;Avise, Jennifer A.;Burke, Gregory L.
背景资料：发展以患者为中心的医疗保健方法需要患者更多地参与自己的护理，包括治疗决策。然而，目前患者参与治疗选择的程度尚未量化，患者是否希望承担更大的决策责任尚不清楚。我们进行了一项前瞻性研究，探讨患者的期望与经验丰富的角色，在治疗决策，治疗结果的特点的看法，并确定重要的来源的information.Methods：病人接受择期血管手术完成了一项调查，包括多项选择，李克特量表，和开放式的问题。统计数据显示为平均值+/-标准差或计数（%）。使用卡方检验（2）或Fisher精确检验（P <0.05）评估手术类别之间的差异，基于1 - 2分的反应，表示重要性、一致性或满意度，基于1 - 5分的Likert量表，其中1 =“非常重要”、“非常同意”或“非常满意”。手术类别包括20例腹主动脉瘤（AAA）修复术、21例动静脉（AV）血液透析通路、20例颈动脉内膜切除术（CEA）和20例下肢外周动脉疾病（PAD）介入治疗。参与者更喜欢讨论所有正在考虑的治疗，而不是只讨论提供者推荐的治疗（90%对56%），并与提供者一起选择，而不是让提供者为他们选择（93%对62%）。虽然参与者表示有足够的信息来提问而不会感到不知所措，但只有77%的人同意他们有机会提问，只有54%的人表示他们有选择。37名参与者（46%）认为他们的第一次治疗是成功的，38%的人认为后续治疗是成功的，16%的人认为他们的治疗都不成功。接受PAD和AV入路手术的参与者最常感到困惑或不知所措（分别为25%和24%，AAA和CEA为0%; P <0.01）。PAD患者最不常获得足够的信息（AAA为70% vs 85%，AV入路为100%，CEA为95%; P = 0.01），对诊断理解的满意度最低（AAA为65% vs 95%，AV入路为100%，CEA为95%; P <0.01），并且大多数患者认为其治疗均不成功（AAA为35%，AV入路为0%，CEA为15%; P = 0.02）。供应商被确定为最重要的信息sources.Conclusions：患者参与血管手术相关的决策水平不一，往往认为他们的治疗不成功。虽然提供者是重要的信息来源，但患者仍然愿意讨论正在考虑的所有选项，并为共同决策做出贡献。
Background: Developing patient-centered approaches to health care requires increased engagement of patients in their own care, including treatment decisions. Current levels of patient involvement in treatment choices have not been quantified, however, and whether patients desire greater decision-making responsibility is unknown. We conducted a prospective study to explore patients' desired vs experienced roles in treatment decisions, characterize perceptions of treatment outcomes, and identify important sources of information.Methods: Patients undergoing elective vascular procedures completed a survey consisting of multiple choice, Likert scale, and open-ended questions. Statistics are displayed as mean +/- standard deviation or count (%). Differences among procedure categories were evaluated using chi(2) or the Fisher exact test at P < .05 based on responses scored 1 to 2, indicating importance, agreement, or satisfaction based on a 1 to 5 Likert scale where 1 = "very important," "strongly agree" or "very satisfied".Results: Of 101 patients who were contacted, 81 participated. Procedure categories included abdominal aortic aneurysm (AAA) repair in 20, arteriovenous (AV) hemodialysis access in 21, carotid endarterectomy (CEA) in 20, and intervention for lower extremity peripheral arterial disease (PAD) in 20. Participants preferred discussion of all treatments being considered vs only the provider's recommended treatment (90% vs 56%) and choosing together with the provider vs having the provider choose for them (93% vs 62%). Although participants indicated adequate information to ask questions without feeling overwhelmed, only 77% agreed that they had the opportunity to ask questions and only 54% indicated that they were offered a choice. Thirty-seven participants (46%) considered their first treatment was successful, 38% considered a subsequent treatment was successful, and 16% considered none of their treatments were successful. Participants undergoing PAD and AV access procedures most often felt confused or overwhelmed (25% and 24%, respectively, vs 0% for AAA and CEA; P < .01). Patients with PAD had adequate information least often (70% vs 85% for AAA, 100% for AV access, and 95% for CEA; P = .01), had the lowest satisfaction with understanding of their diagnosis (65% vs 95% for AAA, 100% for AV access, and 95% for CEA; P < .01), and most often considered none of their treatments successful (35% vs 0% for AAA, 15% for AV access, and 15% for CEA; P = .02). Providers were identified as the most important information source.Conclusions: Patients have variable levels of participation in decision making related to vascular procedures and often consider their treatments unsuccessful. Although providers are important sources of information, patients still prefer to discuss all options being considered and contribute to shared decision making.