Deficits and Variations in Patients' Experience with Making 9 Common Medical Decisions: The DECISIONS Survey
Deficits and Variations in Patients' Experience with Making 9 Common Medical Decisions: The DECISIONS Survey
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DOI：
10.1177/0272989x10380466
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发表时间：
2010-09-01
影响因子：
3.6
通讯作者：
Fagerlin, Angela
中科院分区：
文献类型：
--
作者：
Zikmund-Fisher, Brian J.;Couper, Mick P.;Fagerlin, Angela
背景。尽管许多研究人员在特定的临床环境中研究了患者参与和医患互动，但没有具有全国代表性的数据来表征患者对多种常见医疗决策的决策和医患沟通的看法。目标。确定高血压、高胆固醇血症或抑郁症患者在开始处方药物治疗方面的缺陷和差异；结直肠癌、乳腺癌或前列腺癌的筛查试验；以及膝关节或髋关节置换术，白内障或腰痛的手术，以及确定与患者决策信心相关的因素。设置。通过随机数字拨号识别的美国成年人的全国样本。设计。横断面调查于2006年11月至2007年5月期间进行。参与者。包括2473名40岁及以上说英语的成年人，他们报告在过去2年内进行了上述9项医疗行动中的1项或以上，或与卫生保健提供者讨论过这样做。测量。患者报告了是谁发起了讨论并做出了最终决定，对利弊进行了多少讨论，是否询问了他们的偏好，以及他们对决定“是正确的”的信心。结果。患者驱动决策的比例在不同的决策中差异很大（范围：血压：16%到膝关节/髋关节置换术：48%）。大多数患者（78%-85%）报告说，提供者提出了建议，这些建议通常倾向于采取医疗行动。较少的患者报告说，提供者询问他们的偏好（范围：结肠癌筛查：34%到膝关节/髋关节置换术：80%）或讨论不采取行动的原因（范围：乳腺癌筛查：20%到腰背部手术：80%）。在报告主要是自己做决定的患者（优势比[OR] = 14.6, P < 0.001）或被问及他们的偏好的患者（OR = 1.32, P < 0.01）中，决策信心较高，而在患者-提供者讨论包括反对者的患者中，决策信心较低（OR = 0.74, P = 0.008）。的局限性。回忆偏差可能会影响患者对决策过程的记忆。结论。决策参与者报告说，讨论的比例存在很大差异，讨论包括不采取行动的原因或讨论患者对他们想做什么的偏好。这些因素似乎与患者对决定是“正确的”的信心直接相关。
Background. Although many researchers have examined patient involvement and patient-provider interactions within specific clinical environments, no nationally representative data exist to characterize patient perceptions of decision making and patient-provider communications across multiple common medical decisions. Objective. To identify deficits and variations in the patient experience of making common medical decisions about initiation of prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; and surgeries for knee or hip replacement, cataracts, or lower back pain, as well as to identify factors associated with patient confidence in the decisions. Setting. National sample of US adults identified by random-digit dialing. Design. Cross-sectional survey conducted from November 2006 to May 2007. Participants. Included 2473 English-speaking adults age 40 and older who reported undertaking 1 or more of the above 9 medical actions or discussing doing so with a health care provider within the past 2 years. Measurements. Patients reported who initiated discussions and made the final decisions, how much discussion of pros and cons occurred, whether they were asked about their preferences, and their confidence that the decision "was the right one." Results. The proportion of patient-driven decisions varied significantly across decisions (range: blood pressure: 16% to knee/hip replacement: 48%). Most patients (78%-85%) reported that providers made a recommendation, and such recommendations generally favored taking medical action. Fewer patients reported that providers asked them about their preferences (range: colon cancer screening: 34% to knee/hip replacement: 80%) or discussed reasons not to take action (range: breast cancer screening: 20% to lower back surgery: 80%). Decision confidence was higher among patients who reported primarily making the decision themselves (odds ratio [OR] = 14.6, P < 0.001) or having been asked for their preference (OR = 1.32, P < 0.01) and was lower among patients whose patient-provider discussions included cons (OR = 0.74, P = 0.008). Limitations. Recall biases may affect patients' memories of their decision-making processes. Conclusions. DECISIONS participants reported wide variations in the proportion of discussions that included a conversation about reasons not to take action or a conversation about patients' preferences about what they would like to do. These factors appear directly related to patients' confidence that the decision was "right."