Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial
Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial
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DOI：
10.1016/j.pec.2015.10.011
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发表时间：
2016-04-01
影响因子：
3.5
通讯作者：
Wood, Fiona
中科院分区：
文献类型：
--
作者：
Elwyn, Glyn;Pickles, Tim;Wood, Fiona
目的：评估将专为临床遭遇而设计的工具（即 Option Grids）引入临床实践环境是否会带来更高水平的共同决策。方法：采用阶梯式楔形试验设计，英国奥尔德姆接口诊所的 6 名物理治疗师依次接受指导，了解如何使用 Option Grid 治疗膝骨关节炎。招募了疑似或确诊膝关节骨关节炎的患者，指导前每位临床医生六名患者，指导后每位临床医生六名患者。我们测量了共同决策、患者知识和决策准备程度。结果：总共招募了 72 名患者； 36 人被分配到干预组。干预组的观察者选项评分（范围 0-100）增加了 8.4 分（95% CI 4.4 至 12.2）。平均知识增益为 0.9 分（分数范围 0-5，95% CI，0.3 至 1.5）。就诊时间没有增加。结论：当临床医生使用膝骨关节炎选项网格时，共享决策增加。实践意义：旨在支持治疗方案协作和审议的工具可提高共享决策水平。 (C) 2015 年作者。由爱思唯尔爱尔兰有限公司出版
Objective: To evaluate whether introducing tools, specifically designed for use in clinical encounters, namely Option Grids, into a clinical practice setting leads to higher levels of shared decision making.Methods: A stepped wedge trial design where 6 physiotherapists at an interface clinic in Oldham, UK, were sequentially instructed in how to use an Option Grid for osteoarthritis of the knee. Patients with suspected or confirmed osteoarthritis of the knee were recruited, six per clinician prior to instruction, and six per clinician afterwards. We measured shared decision making, patient knowledge, and readiness to decide.Results: A total of 72 patients were recruited; 36 were allocated to the intervention group. There was an 8.4 point (95% CI 4.4 to 12.2) increase in the Observer OPTION score (range 0-100) in the intervention group. The mean gain in knowledge was 0.9 points (score range 0-5, 95% CI, 0.3 to 1.5). There was no increase in encounter duration.Conclusion: Shared decision making increased when clinicians used the knee osteoarthritis Option Grid.Practice Implications: Tools designed to support collaboration and deliberation about treatment options lead to increased levels of shared decision making. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.