共享决策干预在终末期肾脏病患者透析治疗决策中的应用

Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease

目的评估共享决策(shared decision making,SDM)干预的有效性,以期提高终末期肾脏病患者透析决策质量。方法采用随机对照的研究设计,纳入2021年10-12月重庆市4所三甲医院的72例终末期肾脏病患者,按照区组随机方法分配至干预组(n=36)或对照组(n=36)。干预组接受护士使用患者决策辅助工具(patient decision aids,PDA)进行决策辅导的SDM干预,对照组接受常规透析前教育。研究对象在干预1周后填写决策冲突量表、治疗选择问卷、医院焦虑抑郁量表、决策准备量表,透析后3个月完成SF-36量表和决策后悔量表。主要结局指标为决策冲突量表评分,次要结局指标为治疗选择、焦虑抑郁评分、决策准备评分、生活质量评分和决策后悔评分。结果在干预1周后,干预组的决策冲突评分(P<0.01)、焦虑评分(P=0.005)显著低于对照组,干预组决策准备评分显著高于对照组(P<0.01),干预组对透析治疗不确定的比例显著低于对照组(15.15%vs 34.29%,P=0.026)。在透析后3个月,干预组的生活质量评分中生理总评分显著高于对照组(P=0.004),决策后悔评分显著低于对照组(P=0.002)。结论SDM干预可有效减少终末期肾脏病患者的决策冲突和决策后悔,减轻焦虑水平,同时改善患者的决策准备和生理健康。

Objective To evaluate the effectiveness of shared decision-making(SDM)interventions to improve the quality of dialysis decision-making in patients with end-stage renal disease.Methods A randomized controlled was carried out in 72 patients with end-stage renal disease recruited between October 2021 and December 2021.The patients were randomly assigned into the intervention group(n=36)or the control group(n=36).The intervention group was given SDM interventions in which the nurses used patient decision aids(PDA)for decision-making counseling,while the control group was given routine pre-dialysis education.All patients received the surveys of Decision Conflict Scale,Treatment Choice Questionnaire,Hospital Anxiety and Depression Scale,and Decision Readiness Scale in 1 week after the intervention,and 36-Item Short Form Health Survey(SF-36)and Decision Regret Scale in 3 months after dialysis.The primary endpoint indicator was the score of Decision Conflict Scale,and the secondary ones were treatment choice,and scores of anxiety and depression,decision readiness,quality of life,and decision regret.Results After 1 week of intervention,the scores of decision conflict(P<0.01)and anxiety(P=0.005)were significantly lower,while that of decision preparation(P<0.01)was obviously higher in the intervention group than the control group.The proportion of uncertainty to dialysis in the intervention group was significantly lower than that of the control group(15.15%vs 34.29%,P=0.026).In 3 months after dialysis,the intervention group obtained statistically higher total physiological score(P=0.004)and lower decision regret score(P=0.002)when compared with the control group.Conclusion SDM interventions can effectively reduce decision conflict and decision regret,reduce anxiety level,and improve decision preparation and physiological health for the patients with end-stage renal disease.