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以患者为中心的护理不同方面的价值:针对慢性病患者的一系列离散选择实验

The value of different aspects of person-centred care: a series of discrete choice experiments in people with long-term conditions.

作者信息

Burton Christopher D, Entwistle Vikki A, Elliott Alison M, Krucien Nicolas, Porteous Terry, Ryan Mandy

机构信息

Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK.

HSRU, University of Aberdeen, Aberdeen, UK.

出版信息

BMJ Open. 2017 Apr 26;7(4):e015689. doi: 10.1136/bmjopen-2016-015689.

Abstract

OBJECTIVE

To measure the value the patients place on different aspects of person-centred care.

DESIGN

We systematically identified four attributes of person-centred care. We then measured their value to 923 people with either chronic pain or chronic lung disease over three discrete choice experiments (DCEs) about services to support self-management. We calculated the value of each attribute for all respondents and identified groups of people with similar preferences using latent class modelling.

SETTING

DCEs conducted online via a commercial survey company.

PARTICIPANTS

Adults with either chronic pain (two DCEs, n=517 and 206, respectively) or breathlessness due to chronic respiratory disease (n=200).

RESULTS

Participants were more likely to choose services with higher level person-centred attributes. They most valued services that took account of a person's current situation likelihood of selection increased by 16.9% (95% CI=15.4 to 18.3) and worked with the person on what they wanted to get from life (15.8%; 14.5 to 17.1). More personally relevant information was valued less than these (12.3%; 11.0 to 13.6). A friendly and personal communicative style was valued least (3.8%; 2.7 to 4.8). Latent class models indicated that a substantial minority of participants valued personally relevant information over the other attributes.

CONCLUSION

This is the first study to measure the value patients place on different aspects of person-centred care. Professional training needs to emphasise the substance of clinical communication-working responsively with individuals on what matters to them-as well as the style of its delivery.

摘要

目的

衡量患者对以患者为中心的护理不同方面的重视程度。

设计

我们系统地确定了以患者为中心的护理的四个属性。然后,我们通过三项关于支持自我管理服务的离散选择实验(DCE),衡量了它们对923名患有慢性疼痛或慢性肺病患者的价值。我们计算了所有受访者对每个属性的价值,并使用潜在类别模型确定了偏好相似的人群组。

设置

通过一家商业调查公司在线进行DCE。

参与者

患有慢性疼痛(两项DCE,分别为n = 517和206)或因慢性呼吸道疾病导致呼吸急促的成年人(n = 200)。

结果

参与者更有可能选择具有更高水平以患者为中心属性的服务。他们最重视考虑个人当前状况的服务(选择可能性增加16.9%,95%CI = 15.4至18.3)以及与个人合作实现其生活目标的服务(15.8%,14.5至17.1)。与这些相比,更具个人相关性的信息受重视程度较低(12.3%,11.0至13.6)。友好且个性化的沟通风格受重视程度最低(3.8%,2.7至4.8)。潜在类别模型表明,相当一部分参与者更重视与个人相关的信息而非其他属性。

结论

这是第一项衡量患者对以患者为中心的护理不同方面重视程度的研究。专业培训需要强调临床沟通的实质内容——根据个人关心的事情做出响应——以及沟通方式。

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