医护患共同决策方案在房颤患者预防脑卒中中的应用

doi:10.3761/j.issn.0254-1769.2022.07.002

摘要/Abstract

摘要：

目的探究医护患共同决策方案在房颤患者预防缺血性脑卒中中的应用效果。方法通过文献回顾、专家论证,构建医护患共同决策方案。采用方便抽样法,选取2021年4月—7月浙江省某三级甲等医院有意愿参与治疗决策的62例房颤患者作为研究对象,将患者分为试验组和对照组,每组各31例。试验组采用医护患共同决策方案,对照组采用常规方案。分别对两组临床决策参与程度、医疗决策参与满意度、决策冲突程度以及凝血指标国际标准化比率（international normalized ratio,INR）达标率进行比较分析。结果干预后,试验组临床决策参与程度得分为（42.26±6.38）分,对照组为（26.48±7.31）分,两组比较,差异具有统计学意义（P<0.001）。试验组医疗决策参与满意度得分为（74.68±11.68）分,对照组为（49.68±15.26）分,两组比较,差异具有统计学意义（P=0.04）。试验组决策冲突程度得分为（24.81±6.72）分,对照组为（45.39±8.47）分,两组比较,差异具有统计学意义（P<0.001）。试验组INR达标率为54.17%,对照组为14.29%,两组比较,差异具有统计学意义（P<0.001）。结论房颤患者使用医护患共同决策方案预防缺血性脑卒中,对提高其临床决策参与程度、医疗决策参与满意度、INR达标率以及降低患者决策冲突程度,均有显著的临床意义。

关键词: 房颤, 缺血性脑卒中, 治疗决策, 共同决策, 决策辅助, 护理

Abstract:

Objective To study the application value of the doctor-nurse-patient shared decision-making assistance program in the prevention of stroke in patients with atrial fibrillation. Methods Through literature review and expert discussion,treatment decision aid tools were constructed. The convenience sampling was adopted,and 62 atrial fibrillation patients who were willing to participate in treatment decision-making in a tertiary hospital in Zhejiang Province from April to July 2021 were selected as the research subjects. The patients were divided into a test group and a control group,with 31 patients in each group. The test group adopts the doctor-nurse-patient joint shared decision-making assistance program,and the control group adopts the conventional plan. The actual participation in treatment decision-making of the 2 groups of patients,the satisfaction of patients with participating in treatment decision-making,the conflicts of patients’ decision-making,and the INR compliance rate of the 2 groups of patients were analyzed. Results There were statistically significant differences in the degree of patients’ actual participation in treatment decision-making between 2 groups（P<0.001）.The test group was（42.26±6.38） points,and the control group was（26.48±7.31） points. There were statistically significant differences in patients’ satisfaction with participating in treatment decision-making between groups（P=0.04）. The test group was（74.68±11.68） points,and the control group was（49.68±15.26） points. There were statistical differences in the decision-making conflicts of patients between groups（P<0.001）. The test group was（24.81±6.72） points,and the control group was（45.39±8.47） points. There were statistically significant differences in the INR compliance rate of patients between 2 groups（P<0.001）. The INR compliance rate of the test group was 54.17%,and the INR compliance rate of the control group was 14.29%. Conclusion The treatment decision-making assistance for patients with atrial fibrillation in the prevention of stroke have significant clinical significance on patients’ participation in treatment decision-making,treatment decision-making satisfaction,decision-making conflict and INR compliance rate.

Key words: Atrial Fibrillation, Ischemic Stroke, Decision-Making, Shared Decision-Making, Decision-Making Assistance, Nursing Care

曹丽君, 黄丽华, 蒋建萍, 章琪, 柳元化, 闵雪芬. 医护患共同决策方案在房颤患者预防脑卒中中的应用[J]. 中华护理杂志, 2022, 57(7): 779-784.

CAO Lijun, HUANG Lihua, JIANG Jianping, ZHANG Qi, LIU Yuanhua, MIN Xuefen. The application of a Doctor-Nurse-Patient Shared Decision-Making Assistance program in the prevention of ischemic stroke in patients with atrial fibrillation[J]. Chinese Journal of Nursing, 2022, 57(7): 779-784.

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