The association between patients' preferred treatment after the use of a patient decision aid and their choice of eventual treatment.

Autor: Latenstein CSS; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Thunnissen FM; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Thomeer BJM; Department of Surgery, Bernhoven, Uden, The Netherlands., van Wely BJ; Department of Surgery, Bernhoven, Uden, The Netherlands., Meinders MJ; Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands., Elwyn G; Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA., de Reuver PR; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Jazyk: angličtina
Zdroj: Health expectations : an international journal of public participation in health care and health policy [Health Expect] 2020 Jun; Vol. 23 (3), pp. 651-658. Date of Electronic Publication: 2020 Mar 13.
DOI: 10.1111/hex.13045
Abstrakt: Objective: To investigate the association between patients' preferred treatment and eventual treatment. Second, to compare patients with surgical treatment to watchful waiting in order to identify predictive factors for surgery.
Methods: A single-centre retrospective study was performed between December 2015 and August 2018. Patients (≥18 years) who used a patient decision aid (PDA) for gallstones or inguinal hernia were included. After their first surgical consultation, patients received access to an online PDA. The patients' preferred treatment after the PDA was compared with their choice of eventual treatment. Multivariable regression analyses were performed for predictive factors for surgery.
Results: In total, 567 patients with gallstones and 585 patients with an inguinal hernia were included. Of the patients with gallstones, 121 (21%) preferred watchful waiting, 367 (65%) preferred surgery, and 79 (14%) were not sure. The patients' preferred treatment was performed in 85.9%. Frequent pain attacks (OR 2.1, 95% CI 1.1-3.9, P = .020) and preference for surgery (OR 4.4, 95% CI 1.9-10.1, P = .001) independently predicted surgery. Of the patients with an inguinal hernia, 77 (13.2%) preferred watchful waiting, 452 (78.8%) preferred surgery, and 56 (9.6%) were not sure. The patients' preferred treatment was performed in 86.0%. The preference for surgery (OR 5.2, 95% CI 2.5-10.6, P < .001) independently predicted surgery and worry about complications predicted avoidance of surgery (OR 0.5, 95% CI 0.2-1.0, P = .037).
Conclusion: This study, reflecting current clinical care, shows that patients' preferred treatment after using a PDA matches their eventual treatment choice in 86% of patients with gallstones or an inguinal hernia. In these patients, symptoms and patients' preference for surgery independently predicts eventual choice of surgery.
(© 2020 The Authors Health Expectations published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje