Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care
Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care
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DOI：
10.1136/bmj.323.7311.493
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发表时间：
2001-09-01
影响因子：
105.7
通讯作者：
Haines, A
中科院分区：
文献类型：
--
作者：
Murray, E;Davis, H;Haines, A
目的探讨良性前列腺肥大的决策辅助是否影响决策、健康结局和资源利用。设计随机对照试验。在英国设置了33种一般做法。参与者为112名患有良性前列腺肥大的男性。干预：病人的辅助决定，包括一个交互式多媒体程序，带有小册子和打印摘要。结果测量患者和全科医生对谁做决定、决定冲突、治疗选择和前列腺切除术率、美国泌尿协会症状量表、费用、焦虑、效用和一般健康状况的看法。结果患者和全科医生对辅助决策系统的评价均可接受。与对照组相比，更高比例的患者（32% vs 4%；平均差值28%，95%可信区间14%至40%）及其全科医生（46% vs 25%; 21%， 3%至40%）认为治疗决定主要或仅由干预组患者做出。干预组患者在3个月和9个月时的决策冲突评分明显低于对照组（2.3 v 2.6; - 0.3, - 0.5 to - 0.1, P < 0.01）。在焦虑、一般健康状况、前列腺症状、效用或费用（不包括与视频光盘设备相关的费用）方面，两组之间没有发现差异。结论辅助决策减少了良性前列腺肥大患者的决策冲突，患者在决策过程中发挥了更积极的作用。这样的项目可以在互联网上以低廉的价格提供，而且有充分的理由支持对这些项目进行协调投资，特别是在病人效用很重要的情况下。
Objective To determine whether a decision aid on benign prostatic hypertrophy influences decision making, health outcomes, and resource use.Design Randomised controlled trial.Setting 33 general practices in the United Kingdom.Participants 112 men with benign prostatic hypertrophy.Intervention Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary.Outcome measures Patients' and general practitioners' perceptions of who made the decision, conflict over decisions, treatment choice and prostatectomy rate, American Urological Association symptom scale, costs, anxiety, utility, and general health status.Results Both patients and general practitioners found the decision aid acceptable. A higher proportion of patients (32% v 4%; mean difference 28%,95% confidence interval 14% to 40%) and their general practitioners (46% v 25%; 21%, 3% to 40%) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group. Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at 3 and 9 months (2.3 v 2.6; - 0.3, - 0.5 to - 0.1, P < 0.01 at 3 months). No differences were found between the groups for anxiety general health status, prostatic symptoms, utility, or costs (excluding costs associated with the video disc equipment).Conclusions The decision aid reduced decisional conflict in men with benign prostatic hypertrophy, and the patients played a more active part in decision making. Such programmes could be delivered cheaply over the internet, and there are good arguments for coordinated investment in them, particularly for conditions in which patient utilities are important.