Helping patients make choices about breast reconstruction: a decision analysis approach.
Helping patients make choices about breast reconstruction: a decision analysis approach.
复制标题
帮助患者做出乳房重建的选择：决策分析方法。
DOI：
10.1097/prs.0000000000000514
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发表时间：
2014
影响因子：
3.6
通讯作者：
Markey,MiaK
中科院分区：
文献类型：
--
作者：
Sun,ClementS;Cantor,ScottB;Reece,GregoryP;Fingeret,MichelleC;Crosby,MelissaA;Markey,MiaK
决策分析可以帮助乳房重建患者及其外科医生系统地评估临床替代方案并做出艰难的决定。本文的目的是通过乳房再造的案例研究来帮助整形外科医生指导患者做出决定。通过做出正确的决定，患者的治疗效果可能会得到改善。本文旨在从患者的角度阐述决策分析技术，重点关注她的价值观和偏好。作者通过一个虚构的乳房再造患者介绍了规范决策，并系统地构建了决策基础，帮助她做出正确的决定。作者广泛地确定了乳房重建的替代方案，提出了患者应考虑的结果类型，讨论了概率信息和结果值的来源，并演示了如何做出正确的决定。这里提出的概念可以扩展到整形和重建手术中的其他共同决策问题。此外，作者还讨论了敏感性分析如何测试决策的稳健性以及如何评估决策的质量。作者还提供了帮助在实践中实施这些概念的工具。最后，作者研究了阻碍在重建手术和一般医疗保健中采用患者决策分析的局限性。作者特别强调需要定期收集生活质量信息、自付费用和恢复时间。
Decision analysis can help breast reconstruction patients and their surgeons to methodically evaluate clinical alternatives and make hard decisions. The purpose of this article is to help plastic surgeons guide patients in making decisions though a case study in breast reconstruction. By making good decisions, patient outcomes may be improved. This article aims to illustrate decision analysis techniques from the patient perspective, with an emphasis on her values and preferences. The authors introduce normative decision-making through a fictional breast reconstruction patient and systematically build the decision basis to help her make a good decision. The authors broadly identify alternatives of breast reconstruction, propose types of outcomes that the patient should consider, discuss sources of probabilistic information and outcome values, and demonstrate how to make a good decision. The concepts presented here may be extended to other shared decision-making problems in plastic and reconstructive surgery. In addition, the authors discuss how sensitivity analysis may test the robustness of the decision and how to evaluate the quality of decisions. The authors also present tools to help implement these concepts in practice. Finally, the authors examine limitations that hamper adoption of patient decision analysis in reconstructive surgery and health care in general. In particular, the authors emphasize the need for routine collection of quality-of-life information, out-of-pocket expense, and recovery time.