Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit
Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit
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DOI：
10.1136/jnnp.2006.102509
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发表时间：
2007-06-01
影响因子：
11
通讯作者：
Playford, E. Diane
中科院分区：
文献类型：
--
作者：
Holliday, Rosaline C.;Cano, Stefan;Playford, E. Diane
目的：最近的长期疾病国家服务框架建议患者更多地参与有关其护理的决策。然而，很少有协议支持这一点。一个潜在的有用的方法是目标设定，但很少有人做评估增加患者参与这种方式的附加值。因此，本研究探讨了增加参与目标设定协议在神经康复setting.Design的影响：本研究是一个AB优化的平衡块设计，每个块持续3个月，超过18个月的时间。设置和参与者：患者（n = 201）从住院神经康复单位招募。干预措施：A阶段招募的患者（n = 100）参与“常规”目标设定。患者（n = 101）在B阶段招募的患者参与“增加参与”的目标设定，其中包括一个协议，以帮助他们定义和优先考虑自己的目标。主要结果测量：患者对目标设定的相关性和他们在过程中的自主性的看法;目标的数量，类型和结果;和功能能力水平。B期患者（“增加参与”）设定的目标较少，其中与参与相关的目标明显较多。这些患者认为目标更相关，并表达了更大的自主性和对目标设定的满意度。有没有差异，功能outcomes between groups.Conclusion：这项研究表明，患者更喜欢增加参与的目标设定过程中的标准程序，认为他们的目标更相关和康复更多的病人为中心，尽管没有功能的收益。有效的以病人为中心的护理可以通过使用帮助支持病人确定和沟通他们的优先事项的结构来实现。因此，我们的研究结果表明，患者将受益于更多地参与这方面的临床决策。
Objectives: The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting.Design: The study was an AB optimised balance block design with each block lasting 3 months, over an 18 month period.Setting and participants: Patients (n = 201) were recruited from an inpatient neurological rehabilitation unit.Interventions: Patients ( n = 100) recruited in phase A were involved in "usual practice'' goal setting. Patients ( n = 101) recruited in phase B were involved in "increased participation'' goal setting, which included a protocol to help them define and prioritise their own goals.Main outcome measures: Patients' perceptions of the relevance of goal setting and their autonomy within the process; the number, type and outcome of goals; and level of functional ability.Results: Phase B patients ("increased participation'') set fewer goals, of which significantly more were participation related. These patients perceived the goals to be more relevant, and expressed greater autonomy and satisfaction with goal setting. There were no differences in functional outcomes between the groups.Conclusion: This study has shown that patients prefer increased participation in the goal setting process over standard procedures, perceiving their goals as more relevant and rehabilitation more patient centred despite the absence of functional gains. Effective patient centred care can be realised by using structures that help support patients to identify and communicate their priorities. As such, our findings suggest patients would benefit from greater participation in this aspect of clinical decision making.