| Autor: |
Morgan, Matthew W., Deber, Raisa B., Llewellyn-Thomas, Hilary A., Gladstone, Peter, Cusimano, R.J., O'Rourke, Keith, Tomlinson, George, Detsky, Allan S., Morgan, M W, Deber, R B, Llewellyn-Thomas, H A, Gladstone, P, O'Rourke, K, Tomlinson, G, Detsky, A S |
| Předmět: |
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| Zdroj: |
JGIM: Journal of General Internal Medicine; Oct2000, Vol. 15 Issue 10, p685-693, 9p, 1 Diagram, 5 Charts |
| Abstrakt: |
Objective: To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decision-making process involving treatment choices for ischemic heart disease, on patient decision-making.Design: Randomized, controlled trial.Setting: The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada.Participants: Two hundred forty ambulatory patients withMeasurements and Main Results: The primary outcome was patient satisfaction with the decision-making process. This was measured using the 12-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores. Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patient-angiographer disagreement about treatment decisions.Conclusions: There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decision-making autonomy without apparent impact on quality of life. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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