Eckman Mark H, Kopras Elizabeth J, Montag-Leifling Karen, Kirby Lari P, Burns Lisa, Indihar Veronica M, Joseph Patricia M
Division of General Internal Medicine and the Center for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio.
Pediatric Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (LB, PMJ).
MDM Policy Pract. 2017 Jun 23;2(1):2381468317715621. doi: 10.1177/2381468317715621. eCollection 2017 Jan-Jun.
Patients with cystic fibrosis (CF) undertake time-consuming programs of home therapies. Our objective was to develop a tool to help CF patients prioritize personal goals for some of these treatments. We describe the development and results of initial evaluation of this shared decision-making tool. Multicriteria decision-making method to develop a shared decision-making tool that integrates patient's values and perceptions of treatment impact on functionality/sense of well-being. Treatment efficacy data obtained through comprehensive review of English language literature and Cochrane reviews. Field study of 21 patients was performed to assess acceptability of the approach, understandability of the tool, and to determine whether there was sufficient patient-to-patient variability in treatment goals and patient preferences to make use of a personalized tool worthwhile. Patients found the tool easy to understand and felt engaged as active participants in their care. The tool was responsive to variations in patient preferences. Priority scores were calculated (0-1.0 ± SD). Patients' most important treatment goals for improving lung health included improving breathing function (0.27 ± 0.11), improving functionality/sense of well-being (0.24 ± 0.13), preventing lung infection (0.21 ± 0.08), minimizing time to complete treatments (0.16 ± 0.12), and minimizing cost (0.11 ± 0.09). A shared decision-making tool that integrates patients' values and best evidence is feasible and could result in improved patient engagement in their own care.
囊性纤维化(CF)患者需要进行耗时的家庭治疗计划。我们的目标是开发一种工具,以帮助CF患者确定其中一些治疗的个人目标优先级。我们描述了这种共同决策工具的开发过程和初步评估结果。采用多标准决策方法开发一种共同决策工具,该工具整合了患者的价值观以及对治疗对功能/幸福感影响的认知。通过全面回顾英语文献和Cochrane综述获得治疗效果数据。对21名患者进行了实地研究,以评估该方法的可接受性、工具的可理解性,并确定治疗目标和患者偏好方面是否存在足够的患者间差异,以使使用个性化工具具有价值。患者发现该工具易于理解,并感觉自己作为积极参与者参与到了护理中。该工具对患者偏好的变化有响应。计算了优先级分数(0 - 1.0 ±标准差)。患者改善肺部健康的最重要治疗目标包括改善呼吸功能(0.27 ± 0.11)、改善功能/幸福感(0.24 ± 0.13)、预防肺部感染(0.21 ± 0.08)、尽量减少完成治疗的时间(0.16 ± 0.12)以及尽量降低成本(0.11 ± 0.09)。一种整合患者价值观和最佳证据的共同决策工具是可行的,并且可以提高患者对自身护理的参与度。