PATIENT REACTIONS TO A PROGRAM DESIGNED TO FACILITATE PATIENT PARTICIPATION IN TREATMENT DECISIONS FOR BENIGN PROSTATIC HYPERPLASIA
PATIENT REACTIONS TO A PROGRAM DESIGNED TO FACILITATE PATIENT PARTICIPATION IN TREATMENT DECISIONS FOR BENIGN PROSTATIC HYPERPLASIA
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DOI：
10.1097/00005650-199508000-00003
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发表时间：
1995-08-01
期刊：
影响因子：
3
通讯作者：
WENNBERG, JE
中科院分区：
文献类型：
--
作者：
BARRY, MJ;FOWLER, FJ;WENNBERG, JE
患者通常需要有关其病情的大量信息，增强患者的参与可能会减少不必要的实践变化并改善医疗决策。作者评估了患有良性前列腺增生的男性对旨在促进参与决策的教育计划的反应，以及对他们的症状状态和并发症的前景的评价在多大程度上预测了他们的治疗选择。一项前瞻性队列研究在三个医院泌尿科诊所进行：两个是预付费团体诊所，一个是退伍军人管理局诊所。纳入了 421 名患有良性前列腺增生症状且未进行前列腺切除术或良性前列腺增生并发症的男性，其中 373 名提供了可用的评级。受试者参加了一个基于交互式视频光盘的共享决策项目，内容涉及良性前列腺增生及其治疗方案、前列腺切除术和“观察等待”。他们对项目的长度、清晰度、平衡性和价值进行评分，并随访 3 个月以确定是否接受手术。患者对该计划的评价是总体清晰、信息丰富且平衡。在所有三个中心，77% 的患者对该计划在做出治疗决策方面的有用性表示非常积极，16% 的患者普遍持积极态度。预测手术治疗选择的逻辑模型记录了当前症状状态的负面评价（比值比 7.0，95% 置信区间 2.9-16.6）以及术后性功能障碍的前景（比值比 0.20，95% 置信区间 0.08-0.48）在决策中的独立重要性。患者对共享决策计划的评价非常积极，并做出了符合他们评估偏好的决定。这些结果表明，可以帮助患者参与治疗决策，并支持共享决策计划的随机试验。
Patients often want considerable information about their conditions, and enhanced patient participation might reduce unwanted practice variation and improve medical decisions. The authors assessed how men with benign prostatic hyperplasia reacted to an educational program designed to facilitate participation in decisionmaking, and how strongly ratings of their symptom state and the prospect of complications predicted their treatment choice. A prospective cohort study was conducted in three hospital-based urology practices: two in prepaid group practices, and one Veterans Administration clinic. Four hundred twenty-one men with symptomatic benign prostatic hyperplasia without prior prostatectomy or benign prostatic hyperplasia complications were enrolled, and 373 provided usable ratings. Subjects participated in an interactive videodisc-based shared decisionmaking program about benign prostatic hyperplasia and its treatment options, prostatectomy, and ''watchful waiting.'' They rated the length, clarity, balance, and value of the program and were followed for 3 months to determine if they underwent surgery. Patients rated the program as generally clear, informative, and balanced. Across all three sites, 77% of patients were very positive and 16% were generally positive about the program's usefulness in making a treatment decision. Logistic models predicting choice of surgical treatment documented the independent importance of negative ratings of the current symptom state (odds ratio 7.0, 95% confidence interval 2.9-16.6), as well as the prospect of postoperative sexual dysfunction (odds ratio 0.20, 95% confidence interval 0.08-0.48) in decisionmaking. Patients rated the Shared Decisionmaking Program very positively and made decisions consistent with their assessed preferences. These results suggest that patients can be helped to participate in treatment decisions, and support a randomized trial of the Shared decisionmaking Program.