Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care
Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care
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DOI：
10.1136/bmj.323.7311.490
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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
目的确定是否激素替代疗法的决策援助影响决策和健康outcomes.Design随机对照试验设置26个一般的做法在英国的参与者205名妇女考虑激素替代疗法。干预Patients' decision aid comprising of a interactive multimedia programme with booklet and printed summary.Outcome measures Patients' and general practitioners'perception of who made the decision，decision-isional conflict，treatment choice，menopause symptoms，costs，anxiety，and general health states.Results Patients and general practitioners found the decision aid acceptable.在3个月时，干预组的决策冲突平均得分显著低于对照组（2.5 v2.8;平均差异-0.3，95%置信区间-0.5至0.2）;这种差异在随访期间保持不变。较高比例的全科医生认为，治疗决定已作出“主要或唯一”的病人在干预组比MI的对照组（55%对31%; 24%，8%至40%）。在3个月时，干预组中未决定治疗的女性比例低于对照组（14% vs26%; -12%，- 23%至- 0.4%），而决定反对激素替代疗法的比例较高（46% vs32%; 14%，1%至28%）;这些差异在9个月时不再明显。两组之间的焦虑，卫生服务资源的使用，一般健康状况，或效用没有差异。较高的成本的干预，主要是由于使用的视频光盘technology.Conclusions互动式多媒体决策援助在NHS将受欢迎的患者，减少决策冲突，使患者在决策中发挥更积极的作用，而不会增加焦虑。使用基于网络的技术将降低干预的成本。
Objective To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes.Design Randomised controlled trial.Setting 26 general practices in the United Kingdom.Participants 205 women considering hormone replacement therapy. 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, decisional conflict, treatment choice, menopausal symptoms, costs, anxiety, and general health status.Results Both patients and general practitioners found the decision aid acceptable. At three months, mean scores for decisional conflict were significantly lower in the intervention group than in the control group (2.5 v 2.8; mean difference - 0.3, 95% confidence interval - 0.5 to - 0.2); this difference was maintained during follow up. A higher proportion of general practitioners perceived that treatment decisions had been made "mainly or only" by the patient in the intervention group than mi the control group (55% v 31%; 24%, 8% to 40%). At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment (14% v 26%; - 12%, - 23% to - 0.4%), and a higher proportion had decided against hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differences were no longer apparent by nine months. No differences were found between the groups for anxiety, use of health service resources, general health status, or utility. The higher costs of the intervention were largely due to the video disc technology used.Conclusions An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and enable patients to play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.