基于Ottawa决策支持框架的植入型心律转复除颤器患者决策辅助工具编制

Development of Decision Aid with Ottawa Decision Support Framework for Patients with Implantable Cardioverter Defibrillator

目的构建符合中国医疗背景的植入型心律转复除颤器的患者决策辅助工具,为其决策制定提供解决思路,以期促进医患共同决策发展。方法在Ottawa决策支持框架理论指导下,通过文献分析形成植入型心律转复除颤器患者决策辅助工具初版;经12名心律失常领域专家的2轮咨询,形成该工具修订版;已安装患者及家属对该工具接受度评估调试,修订形成工具终版。结果基于证据整合形成工具初版包括6项一级指标、38项二级指标;2轮专家函询权威程度为0.91,协调系数(Kendall’s W)分别为0.154,0.161,专家评审权威可靠;工具接受度测试显示该工具具有可接受性和实用性;最终植入型心律转复除颤器患者决策辅助工具包含7项一级指标:决策阶段评估、信息提供、利弊分析、价值澄清、支持系统、决策倾向性、决策确认,及41项二级指标。结论植入型心律转复除颤器患者决策辅助工具具备科学性实用性,实现了最佳临床证据和患者价值取向统一,为安装植入型心律转复除颤器患者的决策困难问题提供解决思路。

Objective To develop a Patient Decision Aid(PtDA) moderating treatment-related uncertainty and helping patients with implantable cardioverter defibrillators(ICDs) to make well-informed decisions. Methods Development of the PtDA was guided by The Ottawa Decision Support Framework(ODSF) and International Patient Decision Aid Standards(IPDAS) quality criteria. After literature analysis, we formulated the draft of PtDA and a revised version was developed after 2-rounds expert consultation. The assessment of the revised PtDA was conducted among patients with ICD and their families and then the final version of Pt DA was formed. Results The initial version of PtDA included 6 first-level and 38 second-level indicators. The authority coefficient of tworound expert consultation was 0.91 and coordination coefficient was 0.154 and 0.161 respectively. Tool acceptance testing showed that PtAD was acceptable and practical. The final PtDA consisted of 7 first-level indicators including decision needs assessment,information providing, pros and cons analysis, value clarification, support system, decision-making orientation, and decision confirmation and 41 second-level indicators. Conclusion Being scientific and practical, Pt AD is the combination of best clinical evidence and patient value, which provides a strategy for problems and difficulties in the decision-making process of ICD patients.