Development and Pilot Testing of an Encounter Tool for Shared Decision Making About the Treatment of Graves' Disease
Development and Pilot Testing of an Encounter Tool for Shared Decision Making About the Treatment of Graves' Disease
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DOI：
10.1089/thy.2015.0277
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发表时间：
2015-11-01
期刊：
影响因子：
6.6
通讯作者：
Montori, Victor M.
中科院分区：
文献类型：
--
作者：
Brito, Juan P.;Castaneda-Guarderas, Ana;Montori, Victor M.
背景：Graves病(GD)患者的最佳治疗选择取决于每个人的情况以及治疗选择之间的差异在解决他们的疾病方面对他们有多重要。本研究的目的是开发和测试一种用于患者和临床医生参与关于GD治疗的共同决策的遭遇决策工具(GD Choice)。为了评估该工具的影响，进行了一项前后对照研究，评估了GD Choice与常规护理(UC)的使用情况。结果：68名患者进入研究，其中UC 37例，GD Choice 31例。在基线时，这两组人是相似的。两组患者的治疗讨论时长相似。就诊后，两组患者对这些选择有相似的了解，但GD Choice患者对治疗并发症的了解明显更多(正确回答的比例分别为83%和55%；p=0.04)。与UC组相比，GD Choice组的患者在临床会面录像中观察到的决策参与程度更高(平均选项量表得分，35%比30%；p=0.02)，但报告的决策舒适度和参与共享决策的水平相似。结论：GD Choice组在不增加会诊时间的情况下增加了对决策过程的参与和对介入并发症的了解。这些有希望的结果支持在一项大型多中心试验中进行GD Choice与UC的随机试验。
Background: The best treatment option for patients with Graves' disease (GD) depends on each person's situation and how the differences between the treatment options matter to them in bringing resolution to their illness. The objective of this study was to develop and test an encounter decision tool (GD Choice) for patients and clinicians to engage in shared decision making about the treatment of GD.Methods: GD Choice was developed using an iterative process based on the principles of interaction design and participatory action research. To evaluate the impact of the tool, a controlled before-after study was conducted, assessing the use of GD Choice versus usual care (UC).Results: Sixty-eight patients were enrolled, 37 to UC and 31 to GD Choice. At baseline, the groups were similar. Treatment discussion length was similar in both arms. After their visit, patients in both groups had similar knowledge about the options, except for GD Choice patients knowing significantly more about the complications of treatment (correctly answered by 83% vs. 55%; p=0.04). Compared with UC, patients in the GD Choice arm had greater involvement in decision making observed on video recordings of clinical encounters (mean OPTION scale score, 35% vs. 30%; p=0.02), but reported similar levels of decisional comfort and participation in shared decision making.Conclusions: GD Choice increases engagement in the decision-making process and knowledge regarding intervention complications without increasing the length of consultation. These promising results support the conduct of a randomized trial of GD Choice versus UC in a large multicenter trial.