Development and pilot testing of a conversation aid to support the evaluation of patients with thyroid nodules.
Development and pilot testing of a conversation aid to support the evaluation of patients with thyroid nodules.
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DOI：
10.1111/cen.14599
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发表时间：
2022-04
影响因子：
3.2
通讯作者：
Brito JP
中科院分区：
文献类型：
--
作者：
Singh Ospina NM;Bagautdinova D;Hargraves I;Barb D;Subbarayan S;Srihari A;Wang S;Maraka S;Bylund CL;Treise D;Montori V;Brito JP
为了支持以患者为中心的护理以及患者和临床医生的合作，我们开发并试点测试了甲状腺结节患者的谈话辅助工具。我们开发了一个基于网络的甲状腺结节对话援助（TNOC）以下以人为本的设计。进行了一项概念验证观察性前后研究[TNOC与常规护理（UC）]，以评估TNOC对对话质量的影响。数据来源包括临床访视记录、就诊后调查和电子健康记录审查。报告了汇总统计量和组间比较。分析了65例患者（UC组32例，TNOC组33例）。大多数患者为女性（89%），中位年龄为57岁，偶然发现甲状腺结节（62%）。大多数甲状腺结节的甲状腺癌风险较低（71%），中位大小为1.4 cm。在基线时，除了TNOC队列的计算能力较高外，各组相似。TNOC的使用与患者参与决策过程、临床医生满意度和决策相关主题讨论的增加相关。此外，在TNOC队列中，注意到决策冲突减少，甲状腺活检作为下一步管理步骤减少。在知识转移、咨询时间、甲状腺癌风险认知或对甲状腺癌诊断的关注方面没有发现差异。在这项初步观察性研究中，在临床实践中使用TNOC是可行的，似乎有助于患者和临床医生的合作。
To support patient centered care and the collaboration of patients and clinicians, we developed and pilot tested a conversation aid for patients with thyroid nodules. We developed a web-based Thyroid NOdule Conversation aid (TNOC) following a human-centered design. A proof of concept observational pre–post study was conducted [TNOC vs. usual care (UC)] to assess the impact of TNOC on the quality of conversations. Data sources included recordings of clinical visits, post encounter surveys, and review of electronic health records. Summary statistics and group comparisons are reported. Sixty five patients were analyzed (32 in the UC and 33 in the TNOC cohort). Most patients were women (89%) with a median age of 57 years and were incidentally found to have a thyroid nodule (62%). Most thyroid nodules were at low risk for thyroid cancer (71%) and the median size was 1.4 cm. At baseline, the groups were similar except for higher numeracy in the TNOC cohort. The use of TNOC was associated with increased involvement of patients in the decision making process, clinician satisfaction, and discussion of relevant topics for decision making. In addition, decreased decisional conflict and fewer thyroid biopsies as next management step was noted in the TNOC cohort. No differences in terms of knowledge transfer, length of consultation, thyroid cancer risk perception or concern for thyroid cancer diagnosis were found. In this pilot observational study, using TNOC in clinical practice was feasible and seemed to help the collaboration of patients and clinicians.
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