Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variable...Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.展开更多
目的对成年癌症患者决策辅助工具应用体验进行系统整合,为开发我国本土化决策辅助工具、实现共享决策提供循证指导。方法计算机检索PubMed、Cochrane Library、CINAHL、Embase、Web of Science、ProQuest、中国知网、万方数据库、维普...目的对成年癌症患者决策辅助工具应用体验进行系统整合,为开发我国本土化决策辅助工具、实现共享决策提供循证指导。方法计算机检索PubMed、Cochrane Library、CINAHL、Embase、Web of Science、ProQuest、中国知网、万方数据库、维普网、中国生物医学文献数据库中关于癌症患者决策辅助工具应用体验的质性研究,检索时限为建库至2023年7月。采用JBI循证卫生保健中心质性研究质量评价标准(2020)进行文献质量评价,以Meta整合方法对文献研究结果进行整合。结果纳入17篇文献,提炼出50个研究结果,归纳出7个类别,最终形成3个整合结果:患者对决策辅助工具总体满意度较高、增强患者决策参与体验、阻碍因素。结论决策辅助工具可以帮助癌症患者了解治疗方案并积极参与决策,满足患者的决策需求,缓解决策冲突,从而改善患者的临床结局。展开更多
BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical per...BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical perceptions.AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.RESULTS The PS rate after sphincter-saving surgery was 15.1%(59/391) in our study after a median follow-up of 47.3 mo(range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903(95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.展开更多
基金The Instituto de Salud Carlos III, FEDER Union Europea (Grant No. PI10/00955).
文摘Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.
文摘目的对成年癌症患者决策辅助工具应用体验进行系统整合,为开发我国本土化决策辅助工具、实现共享决策提供循证指导。方法计算机检索PubMed、Cochrane Library、CINAHL、Embase、Web of Science、ProQuest、中国知网、万方数据库、维普网、中国生物医学文献数据库中关于癌症患者决策辅助工具应用体验的质性研究,检索时限为建库至2023年7月。采用JBI循证卫生保健中心质性研究质量评价标准(2020)进行文献质量评价,以Meta整合方法对文献研究结果进行整合。结果纳入17篇文献,提炼出50个研究结果,归纳出7个类别,最终形成3个整合结果:患者对决策辅助工具总体满意度较高、增强患者决策参与体验、阻碍因素。结论决策辅助工具可以帮助癌症患者了解治疗方案并积极参与决策,满足患者的决策需求,缓解决策冲突,从而改善患者的临床结局。
基金Supported by the Taipei Medical University,No. TMU104-AE1-B35。
文摘BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical perceptions.AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.RESULTS The PS rate after sphincter-saving surgery was 15.1%(59/391) in our study after a median follow-up of 47.3 mo(range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903(95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.
