Helping Families Make Difficult Choices: Creation and Implementation of a Decision Aid for Neuromuscular Scoliosis Surgery
Helping Families Make Difficult Choices: Creation and Implementation of a Decision Aid for Neuromuscular Scoliosis Surgery
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DOI：
10.1097/bpo.0000000000000382
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发表时间：
2015-12-01
影响因子：
1.7
通讯作者：
Wysocki, Tim
中科院分区：
文献类型：
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作者：
Shirley, Eric;Bejarano, Carolina;Wysocki, Tim
背景：决策辅助工具有助于家庭在共同决策 (SDM) 过程中与医生进行有意义的讨论。尽管 SDM 流程主要用于成人医疗机构，但我们试图开发一种用于儿科的决策辅助工具。由于考虑手术时决策的复杂性，选择了神经肌肉性脊柱侧凸的治疗方法。我们的目标是确定该工具是否会提高家庭的知识和满意度，同时减少决策冲突。方法：决策辅助是使用多步骤过程创建的，以提供有关神经肌肉脊柱侧凸治疗方案的风险和益处的公正的基于证据的信息。初稿由一位整形外科医生撰写，然后由多学科小组进行格式化，以满足国际决策援助标准。该文件经过了当地、国家和国际同行评审，然后由一家机构的 4 名骨科医生进行预期实施。对决策辅助工具进行了评估和修订，以供进一步使用。 结果：研究包括 11 名儿童，平均年龄 12 岁（范围：8 至 17 岁）。 11个家庭中有9个选择了手术。知识测试的平均分从 3.0（范围，2 到 5）增加到 4.0（范围，3 到 5），可能为 5 分（P = 0.067）。 SDM 满意度量表的平均项目得分为 3.8（范围为 3.5 至 4.0）。 SURE 决策冲突测试的平均分为 3.7 分（范围为 3 至 4），最高分为 4。临床医生 SDM 满意度量表的平均总分为 22.5（范围为 17 至 25）。结论：为这一复杂决策创建的决策辅助工具提高了知识获取、满意度和决策冲突，同时获得了使用它的医生的认可。应考虑在专业协会内开发额外的决策辅助工具，以最大限度地提高效率和共识。
Background: Decision aids serve to prepare families for a meaningful discussion with their physician during the shared decision-making (SDM) process. Although SDM processes have been used primarily in adult health care settings, we sought to develop a decision aid for use in pediatrics. The treatment of neuromuscular scoliosis was selected due to the complexity of decision making when surgery is considered. Our objective was to determine whether this tool would improve families' knowledge and satisfaction while decreasing decisional conflict.Methods: The decision aid was created using a multistep process to provide unbiased evidence-based information about the risks and benefits of the treatment options for neuromuscular scoliosis. The initial draft was written by an orthopaedic surgeon and then formatted by a multidisciplinary group to meet international decision aid standards. The document underwent local, national, and international peer review before prospective implementation by 4 orthopaedic surgeons at a single institution. The decision aid was evaluated and revised for further use.Results: Eleven children, mean age 12 years (range, 8 to 17 y), were included in the study. Nine of the 11 families opted for surgery. The mean scores on the knowledge test increased from 3.0 (range, 2 to 5) to 4.0 (range, 3 to 5) of a possible 5 points (P = 0.067). The mean item score on the SDM satisfaction scale was 3.8 (range, 3.5 to 4.0). The mean score on the SURE test for decisional conflict was 3.7 (range, 3 to 4) of a maximum score of 4. The mean total score on the clinician SDM satisfaction scale was 22.5 (range, 17 to 25).Conclusions: The decision aid created for this complex decision resulted in improvements in knowledge gain, satisfaction, and decisional conflict while gaining acceptance of the physicians who utilized it. Consideration should be given to developing additional decision aids within professional societies to maximize efficiency and consensus.