Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening.
Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening.
复制标题
解析肺癌筛查中共享决策与决策质量、筛查决策和筛查完成之间的关系。
DOI：
10.1016/j.pec.2024.108143
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发表时间：
2024
影响因子：
3.5
通讯作者：
Rawl,SusanM
中科院分区：
文献类型：
--
作者：
Carter-Bawa,Lisa;SlavenJr,JamesE;Monahan,PatrickO;Brandzel,Susan;Gao,Hongyuan;Wernli,KarenJ;Lafata,JenniferElston;Rawl,SusanM
目的肺癌筛查是一项复杂的个体化决策。为了了解如何最好地支持患者在这一决定，我们必须了解如何共享决策是与决策和行为outcome.MethodsObservational队列研究相结合的电子健康记录数据的肺筛查合格的患者最近从事一个共享的决策讨论有关筛选与初级保健clinics.ResultsUsing多变量分析（n = 529），与较高的肺癌筛查决策质量相关的因素包括（OR = 1.33，p < .0001），较低的感知益处（OR = 0.90，p = .0004），较高的感知障碍（OR = 1.07，p < .0001），自我效能感较高（OR = 1.13，p < .0001），并且分享了更高水平的感知讨论（OR = 1.04，p <0.0001）。与患者决定筛查相关的因素包括年龄较大（OR = 1.12，p = 0.0050）和较高的自我效能（OR = 1.11，p = 0.0407）。与筛查完成相关的因素包括年龄较大（OR = 1.05，p = 0.0050）、知识水平较高（OR = 1.24，p = 0.0045）和自我效能感较高（OR = 1.12，p = 0.0003.ConclusionsShared decision-making in lung cancer screening is a dyadic process between patient and clinical.随着我们继续努力实现以患者为中心的高质量护理，患者决策质量可能会通过针对关键因素（如高质量知识，自我效能）和促进共享讨论来提高，以支持患者参与肺癌筛查决策。
ObjectivesLung cancer screening is a complex and individualized decision. To understand how best to support patients in this decision, we must understand how shared decision-making is associated with both decisional and behavioral outcomes.MethodsObservational cohort study combining patient survey data with electronic health record data of lung screening-eligible patients who recently engaged in a shared decision-making discussion about screening with a primary care clinician.ResultsUsing multivariable analysis (n = 529), factors associated with higher lung cancer screening decisional quality include higher knowledge (OR = 1.33,p< .0001), lower perceived benefits (OR = 0.90,p= .0004), higher perceived barriers (OR = 1.07,p< .0001), higher self-efficacy (OR = 1.13,p< .0001), and higher levels of perceiving the discussion was shared (OR = 1.04,p< .0001).Factors associated with the patient’s decision to screen include older age (OR = 1.12,p= .0050) and higher self-efficacy (OR = 1.11,p= .0407). Factors associated with screening completion included older age (OR = 1.05,p= .0050), higher knowledge (OR = 1.24,p= .0045), and higher self-efficacy (OR = 1.12,p= .0003).ConclusionsShared decision-making in lung cancer screening is a dyadic process between patient and clinician. As we continue to strive for high-quality patient-centered care, patient decision quality may be enhanced by targeting key factors such as high-quality knowledge, self-efficacy, and fostering a shared discussion to support patient engagement in lung cancer screening decisions.