年龄相关性黄斑变性患者营养干预决策辅助方案的构建及应用

doi:10.3761/j.issn.0254-1769.2022.23.008

摘要/Abstract

摘要：

目的探讨营养干预决策辅助方案在年龄相关性黄斑变性患者中的应用效果。方法通过参考国内外文献、专家函询、课题小组讨论以及预试验，基于共同决策三阶段会谈模型构建年龄相关性黄斑变性患者营养干预决策辅助方案，包括团队会谈、选择会谈、决策会谈3个步骤。2021年3月—12月便利选取重庆市某三级甲等综合医院眼科110例年龄相关性黄斑变性患者，采用随机数字表法分为试验组和对照组各55例。试验组在常规健康教育的基础上实施决策辅助方案，对照组给予常规健康教育。干预后分别使用年龄相关性黄斑变性营养相关知识测评问卷、决策准备量表、决策自我效能量表、决策困境量表、综合医院焦虑/抑郁情绪测定表对两组进行评估。结果试验组干预后营养相关知识测评问卷得分高于对照组（P<0.001），决策准备量表得分高于对照组（P<0.001）；决策自我效能量表得分高于对照组（P<0.001），决策困境量表得分低于对照组（P<0.001）；试验组焦虑/抑郁情绪测定表得分低于对照组（P<0.05）。结论应用该研究制订的患者决策辅助方案，可提高患者营养干预相关知识水平，提高患者的决策准备度和决策自我效能，降低患者决策困境水平，改善患者焦虑/抑郁情绪。

Abstract:

Objective To explore the application effect of the nutritional intervention decision-making assistance program in patients with age-related macular degeneration（AMD）. Methods By referring to the domestic and foreign literature，expert consultation，topic group discussions and pre-experiment，based on the Three Talk Model of shared decision making，the nutritional intervention decision support scheme for AMD patients was constructed，including 3 steps of team negotiation，selection negotiation and decision negotiation. A total of 110 AMD patients were conveniently selected and randomly divided into an experimental group and a control group with 55 cases in each group. The experimental group was given the decision support program on the basis of routine health education，and the control group was given routine health education. Before and after the intervention，the 2 groups of patients were assessed with the knowledge of risks and benefits of nutrition in AMD，Preparation Decision-making Scale（PrepDM），Decision Making Self-Efficacy Scale（DM-SES），Decision Conflict Scale（DCS），and Hospital Anxiety and Depression Scale（HADS）. Results After the intervention，the scores of knowledge of risks and benefits of nutrition in the experimental group were higher than those in the control group（P<0.001），and the scores of PrepDM were significantly higher than those in the control group（P<0.001）. DM-SES score was higher than that of the control group（P<0.001）；DCS score was significantly lower than that of the control group（P<0.001）；the scores of HADS in the experimental group were lower than those in the control group（P<0.05）. Conclusion The patient decision-making assistance program developed in this study can improve the knowledge level of nutritional intervention，improve decision-making readiness，improve patient self-efficacy，reduce the level of decision-making dilemma，and alleviate patient anxiety and depression.

Key words: Age-Related Macular Degeneration, Nutrition Therapy, Decision Support System, Clinical, Nursing Care

万君丽, 张凤, 郭文梅, 吴雪梅, 卞薇. 年龄相关性黄斑变性患者营养干预决策辅助方案的构建及应用[J]. 中华护理杂志, 2022, 57(23): 2870-2876.

WAN Junli, ZHANG Feng, GUO Wenmei, WU Xuemei, BIAN Wei. Development and application of decision aid for age-related macular degeneration patients[J]. Chinese Journal of Nursing, 2022, 57(23): 2870-2876.

图/表 5

表1 年龄相关性黄斑变性患者营养干预决策辅助方案

Table 1 Nutrition intervention decision support program for age-related macular degeneration patients

表2 两组一般资料比较

Table 2 General data of patients in 2 groups

表3 干预前后两组年龄相关性黄斑变性营养相关知识与决策准备度得分的比较（分，$\bar{x}$±s）

Table 3 Comparison of nutritional related knowledge and Preparation for Decision Making in 2 groups of patients before and after intervention（score，$\bar{x}$±s）

表4 干预前后两组决策困境与自我效能得分的比较（分，$\bar{x}$±s）

Table 4 Comparison of Decisional Conflict Scale and Decision Making Self-Efficacy Scale in 2 groups of patients before and after intervention（score，$\bar{x}$±s）

表5 干预前后两组焦虑/抑郁得分比较（分，$\bar{x}$±s）

Table 5 Comparison of Hospital Anxiety and Depression Scale in 2 groups of patients before and after

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