目的:了解复发性憩室炎结肠切除术的患者决策过程。
背景:对复发性憩室炎进行择期结肠切除术的决定是高度偏好敏感的。在这个决策过程中,对患者的观点知之甚少。
方法:我们在美国三个中心对复发性憩室炎患者进行了一项定性研究。使用迭代归纳/演绎方法,我们开发了一个概念框架来捕获编码数据中确定的主要主题。
结果:从2019年3月至2020年7月,在三个地点招募了39名患者,并参加了六个重点小组。在使用分层编码系统对转录本进行编码后,建立了一个概念框架。确定的主要主题包括:参与者对手术的信念,例如规范性信仰(例如,主观,对手术的价值),控制信念(例如,自我效能感,变化阶段)和预期结果(例如,期望,预期的遗憾);行为管理策略的作用(例如,纤维,消除不良习惯);情感体验(例如,抑郁症,尴尬);当前症状(例如,严重程度,时间安排);和生活质量(例如,认知负荷,社会心理因素)。确定了影响患者选择的三组调节因素:临床病史(例如,诊断的来源,多次手术),临床方案(例如,术前和术后教育)和提供者特定的因素(例如,专业,外科医生的选择)。
结论:患者通过三个主要主题来看待接受结肠切除术的决定-他们对手术的信念,他们的社会心理背景和影响参与者选择手术的调节因素。这些知识对于咨询正在考虑结肠切除术的患者的临床医生以及研究优化复发性憩室炎护理过程的研究人员都是必不可少的。
OBJECTIVE: Understand the patient\'s decision-making process regarding colectomy for recurrent diverticulitis.
BACKGROUND: The decision to pursue elective colectomy for recurrent diverticulitis is highly preference-sensitive. Little is known about the patient\'s perspective in this decision-making process.
METHODS: We performed a qualitative study utilizing focus groups of patients with recurrent diverticulitis at 3 centers across the United States. Using an iterative inductive/deductive approach, we developed a conceptual framework to capture the major themes identified in the coded data.
RESULTS: From March 2019 to July 2020, 39 patients were enrolled across 3 sites and participated in 6 focus groups. After coding the transcripts using a hierarchical coding system, a conceptual framework was developed. Major themes identified included participants\' beliefs about surgery, such as normative beliefs (eg, subjective, value placed on surgery), control beliefs (eg, self-efficacy, stage of change), and anticipated outcomes (eg, expectations, anticipated regret); the role of behavioral management strategies (eg, fiber, eliminate bad habits); emotional experiences (eg, depression, embarrassment); current symptoms (eg, severity, timing); and quality of life (eg, cognitive load, psychosocial factors). Three sets of moderating factors influencing patient choice were identified: clinical history (eg, source of diagnosis, multiple surgeries), clinical protocols (eg, pre-op and post-op education), and provider-specific factors (eg, specialty, choice of surgeon).
CONCLUSIONS: Patients view the decision to undergo colectomy through 3 major themes: their beliefs about surgery, their psychosocial context, and moderating factors that influence participant choice to undergo surgery. This knowledge is essential both for clinicians counseling patients who are considering colectomy and for researchers studying the process to optimize care for recurrent diverticulitis.