The Role of Patient-Physician Communication on the Use of Hydroxyurea in Adult Patients with Sickle Cell Disease.
The Role of Patient-Physician Communication on the Use of Hydroxyurea in Adult Patients with Sickle Cell Disease.
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医患沟通对成人镰状细胞病患者使用羟基脲的作用。
DOI：
10.1007/s40615-019-00625-5
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发表时间：
2019
影响因子：
3.9
通讯作者：
Eakin,MichelleN
中科院分区：
文献类型：
--
作者：
Jabour,SarahM;Beachy,Sara;Coburn,Shayna;Lanzkron,Sophie;Eakin,MichelleN
目的本定性研究分析了镰状细胞病（SCD）患者对是否服用羟基脲（HU）的决定过程的看法，以及医生沟通在患者决策过程中的作用。方法从2015年10月至2016年7月，我们对SCD患者（N= 20）进行半结构化访谈，并进行录音和转录。参与者年龄≥18岁，是城市成人镰状细胞中心的患者，能够提供知情同意书，并且会说英语。我们迭代开发代码并使用主题分析来组织关键主题。 结果大多数参与者是女性 (65%)、中年人 (M= 44, SD = 12.2)，55% 的 HU 处方平均为 10.4 (SD = 4.7) 年。参与者描述了影响他们关于 HU 治疗决定的 3 个关键因素：(1) 生活方式，(2) 健康状况，以及 (3) HU 特征。关于提供者沟通和 HU 治疗决策出现了四个主题：(1) 提供者的建议，(2) 共同决策，(3) “角力”，以及 (4) 感觉没有被倾听。 结论 参与共同决策的提供者有权让参与者决定是否开始 HU 治疗。那些认为他们的提供者没有倾听他们的担忧的参与者表示不再接受 HU 治疗。在与 SCD 患者讨论 HU 时，提供者必须了解影响患者决策的多方面因素，并授权患者参与此类讨论。需要进一步研究来了解 SCD 患者共同决策的作用，以改善 SCD 的管理。
ObjectiveThis qualitative study analyzed the perspective of patients living with sickle cell disease (SCD) on their process of deciding whether to take hydroxyurea (HU), and the role of physician communication in patients’ decision-making process.MethodsFrom October 2015 to July 2016, we conducted semi-structured interviews among patients with SCD (N= 20) that were audio-recorded and transcribed. Participants were ≥ 18 years old, a patient of an urban adult sickle cell center, able to provide informed consent, and English-speaking. We iteratively developed codes and used thematic analysis to organize the key themes.ResultsMost participants were female (65%), middle aged (M= 44, SD = 12.2), and 55% were prescribed HU for an average of 10.4 (SD = 4.7) years. Participants described 3 key factors that influenced their decision regarding HU treatment: (1) lifestyle, (2) health status, and (3) HU characteristics. Four themes emerged about provider communication and HU treatment decisions: (1) provider’s advisement, (2) shared decision-making, (3) “wrestled,” and (4) not feeling heard.ConclusionProviders who engaged in shared decision–making empowered participants to decide whether to start HU treatment. Participants who felt their providers were not listening to their concerns expressed disengaging from HU treatment. During discussions about HU with patients living with SCD, providers must understand the multi-faceted aspects that impact patients’ decision and empower patients to engage in such discussions. Further research is needed to understand the role of shared decision-making among patients with SCD to improve management of SCD.