Randomized, controlled trial of on interactive videodisc decision aid for patients with ischemic heart disease
Randomized, controlled trial of on interactive videodisc decision aid for patients with ischemic heart disease
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DOI：
10.1046/j.1525-1497.2000.91139.x
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发表时间：
2000-10-01
影响因子：
5.7
通讯作者：
Detsky, AS
中科院分区：
文献类型：
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作者：
Morgan, MW;Deber, RB;Detsky, AS
目的：为确定缺血性心脏病共同决策程序（IHD SDP）对患者决策的影响，设计：随机对照试验，地点：多伦多医院，多伦多大学，多伦多，安大略，加拿大。240例非卧床缺血性心脏病患者适合择期血运重建和正在进行的药物therapy.MEASUREMENTS和主要结果：主要结果是患者的满意度的决策过程。这是使用la项决策过程问卷进行测量的，该问卷在良性前列腺增生SDP的随机试验中开发和验证。次要结局包括患者知识（使用20个关于知情治疗决策所需知识的问题进行测量）、治疗决策、患者-血管造影师对决策的一致性和一般健康评分，在治疗决策时和/或6个月随访时测量结局。干预组和对照组的共享决策程序评分相似（分别为71%和70%; 95%置信区间[CI]为1%差异，-3%至7%）。干预组的知识得分较高（75% vs 62%; 95% CI为13%差异，8%至18%）。干预组选择进行血运重建的频率较低（对照组为58% vs 75%; 95% CI为17%差异，4%至31%）。在6个月时，52%的干预组和66%的对照组接受了血运重建（95% CI为14%差异，0%至28%）。在6个月时，两组的一般健康状况和心绞痛评分没有差异。暴露于IHD SDP导致更多的患者血管造影师不同意治疗decisions.CONCLUSIONS：有没有显着差异的满意度与决策过程评分之间的IHD SDP和常规做法组。IHD SDP患者知识更丰富，接受血运重建（介入治疗）较少，并表现出患者决策自主性增加，对生活质量无明显影响。
OBJECTIVE: To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decisionmaking process involving treatment choices for ischemic heart disease, on patient decision-making.DESIGN:Randomized, controlled trial.SETTING: The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada.PARTICIPANTS: Two hundred forty ambulatory patients with ischemic heart disease amenable to elective revascularization and ongoing medical therapy.MEASUREMENTS AND MAIN RESULTS: The primary outcome was patient satisfaction with the decision-making process. This was measured using the la-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores, Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the Intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patient-angiographer disagreement about treatment decisions.CONCLUSIONS: There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decisionmaking autonomy without apparent impact on quality of life.