Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis.
Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis.
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DOI：
10.1007/s40271-015-0111-6
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Veazie PJ
中科院分区：
文献类型：
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作者：
Dolan JG;Veazie PJ
人们越来越认识到让患者参与偏好驱动的医疗决策的重要性，这凸显了制定实用策略来实施以患者为中心的共同决策的必要性。使用表格资产负债表来支持临床决策的做法已经很成熟。最近的证据表明，图形、交互式决策仪表板可以帮助人们更深入地了解特定决策环境中的信息。因此，我们进行了一项非随机试验，比较将交互式仪表板添加到静态表格资产负债表对患者决策的影响。研究人群由 ResearchMatch 注册中心的成员组成，他们自愿参与医疗决策研究。进行了两项单独的调查：一项针对对照组，另一项针对干预组。所有参与者都被要求想象他们新诊断出患有慢性疾病，并被要求在三种假设的药物治疗之间进行选择，这三种药物治疗的有效性、副作用和自付费用各不相同。两组患者在审查资产负债表后都做出了初步治疗选择。经过短暂的清洗期后，对照组成员在再次查看资产负债表后做出了第二种治疗选择，而干预组成员在查看包含相同信息的交互式决策仪表板后做出了第二种治疗选择。在做出这两种选择后，参与者按照 1-10 分的等级对自己的选择的信心程度进行评分。与对照组相比，仪表板干预组的成员更有可能改变他们对首选药物的选择（10.2% vs. 7.5%，p=0.054），并且决策信心的增加更大：0.67 vs. 0.075，p<0.03。决策冲突或决策援助可接受性方面的组间差异不存在统计学意义。这些发现表明临床决策仪表板可能是一种有效的护理点决策支持工具。需要进一步研究来探索这种可能性。
Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision making. The use of tabular balance sheets to support clinical decision making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive a deeper understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making. The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision making. Two separate surveys were conducted: one for the control group and one for the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and asked to choose between three hypothetical drug treatments that varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief washout period, members of the control group made a second treatment choice after reviewing the balance sheet again while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices participants rated their degree of confidence in their choice on a 1–10 scale. Members of the dashboard intervention group were more likely to change their choice of preferred drug, (10.2% vs. 7.5%, p=0.054) and had a larger increase in decision confidence than the control group: 0.67 vs. 0.075, p<0.03. There were no statistically significant between group differences in decisional conflict or decision aid acceptability. These findings suggest that clinical decision dashboards may be an effective point of care decision support tool. Further research to explore this possibility is warranted.