共享决策实施框架在肺结节治疗中的应用  

Application of the implementation framework for sharing decision making in the treatment of pulmonary nodules

作　　者：潜艳 刘常宇 董翠萍 吴骁伟[1] QIAN Yan;LIU Changyu;DONG Cuiping;WU Xiaowei(Dept.of Thoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科,湖北武汉430030

出　　处：《武汉大学学报（医学版）》2023年第3期350-355,共6页Medical Journal of Wuhan University

基　　金：湖北省自然科学基金资助项目(编号:2020CFB599)。

摘　　要：目的:构建共享决策实施框架,探讨其在胸外科患者肺结节治疗决策中运用的意义。方法:采用文献查证、专家咨询、现状调查、质性研究等方法,析出变量及概念,对概念之间的内在联系进行分析,构建肺结节病人共享决策实施框架;将60名肺结节病人随机分为两组,对照组给予常规治疗谈话,观察组基于共享决策实施框架给予规范的决策支持,应用决策参与程度、平均住院日、生活质量、第1秒呼气的最大容积(FEV1)、医患关系及医疗服务满意度指标判断其临床实践效果。结果:相较于对照组,观察组决策参与程度高(χ^(2)=6.667;P=0.009),平均住院日短(t=2.393;P=0.02),生理维度(t=2.238;P=0.029)及心理维度(t=2.173;P=0.034)生活质量高,FEV1水平高(t=2.512;P=0.014),医患关系(t=2.112;P=0.039)与满意度(t=2.172;P=0.034)得到改善。结论:共享决策实施框架能够指导胸外科肺结节患者制定决策支持策略,提升患者决策参与程度,改善医疗品质,提升患者满意度。Objective: To construct the implementation framework of shared decision making and explore its significance in decision making regarding treatment of pulmonary nodules. Methods: The methods of literature review, expert consultation, investigation and qualitative research were used to separate out variables and concepts, the influencing factors of patients’ participation in clinical decision-making were analyzed, and the internal relationship between concepts was studied to develop the implementation framework for sharing decision making of patients with pulmonary nodules. Sixty patients with pulmonary nodules were divided randomly into two groups. The control group was given routine treatment talk, and the observation group was given standardized decision support based on the shared decision implementation framework. The clinical effect was judged by the indexes of decision participation, average length of stay, quality of life, forced expiratory volume in one second(FEV1),doctor-patient relationship and satisfaction of medical services. Results: The framework was feasible,could promote patients’ participation in shared decision making(χ^(2)=6. 667;P=0. 009), shorten the average length of hospital stay(t=2. 393;P=0. 02), improve the level of FEV1(t=2. 512;P=0. 014), patients’ living quality in physical dimension(t=2. 238;P=0. 029), and mental dimension(t=2. 173;P=0. 034), and improve doctor-patient relationship(t=2. 112;P=0. 039) and satisfaction(t=2. 172;P=0. 034). Conclusion: The implementation framework of shared decision making can guide the formulation of decision support strategies, enhance the degree of patient’s participation in decision making, improve medical quality, and enhance patient’s satisfaction.

关 键 词：肺结节 共享决策 实施框架 医疗品质 病人体验 

分 类 号：R193[医药卫生—卫生事业管理]