背景:手术可以帮助坐骨神经痛引起的腿部疼痛患者更快地恢复,但到12个月时结局与非手术治疗相似.对于许多人来说,手术的决定可能需要反思,和病人决策辅助是一个基于证据的临床工具,可以帮助指导病人通过这个决定。
目的:这项研究的目的是为坐骨神经痛患者开发和完善决策辅助工具,这些患者正在决定是否进行手术或“等待并观察”(即,先尝试非手术治疗)。
方法:使用大声思考用户测试协议的半结构化访谈。
方法:20名临床医生和20名患有下腰痛或坐骨神经痛的患者。
方法:来自技术验收模型的项目,准备决策量表和决策质量仪器2.0(知识仪器)。
方法:原型将相关研究与工作组观点整合在一起,决策辅助标准和健康素养指南。研究团队通过七轮用户测试,完善了原型,其中包括讨论用户测试反馈和实施更改,然后进行下一轮。
结果:作为工作组反馈的结果,决策援助分为几个部分:以前,在拜访外科医生期间和之后。在所有的用户测试中,临床医生对资源的评价为5.9/7(SD=1.0)的感知有用性,和6.0/7的感知易用性(SD=0.8)。患者报告说决策援助很容易理解,平均正确回答3.4/5有关坐骨神经痛手术的知识问题(SD=1.2)。该网站的年级阅读分数为9.0。患者在决策准备方面得分很高(4.4/5,SD=0.7),暗示了赋予患者权力的强大潜力。访谈反馈显示,患者和临床医生认为决策辅助工具将鼓励提问并帮助患者反思个人价值观。
结论:临床医生发现决策辅助是可以接受的,患者发现这很容易理解,两组都认为这将使患者能够积极参与他们的护理,并做出符合个人价值观的明智决定。工作组的输入和用户测试对于确保决策辅助工具满足患者和临床医生的需求至关重要。
■患者和临床医生通过工作组为原型开发做出了贡献。
BACKGROUND: Surgery can help patients with leg pain caused by
sciatica recover faster, but by 12 months outcomes are similar to nonsurgical management. For many the decision to have surgery may require reflection, and patient decision aids are an evidence-based clinical tool that can help guide patients through this decision.
OBJECTIVE: The aim of this study was to develop and refine a decision aid for patients with
sciatica who are deciding whether to have surgery or \'wait and see\' (i.e., try nonsurgical management first).
METHODS: Semistructured interviews with think-aloud user-testing protocol.
METHODS: Twenty clinicians and 20 patients with lived experience of low back pain or
sciatica.
METHODS: Items from Technology Acceptance Model, Preparation for Decision Making Scale and Decision Quality Instrument for Herniated Disc 2.0 (knowledge instrument).
METHODS: The prototype integrated relevant research with working group perspectives, decision aid standards and health literacy guidelines. The research team refined the prototype through seven rounds of user-testing, which involved discussing user-testing feedback and implementing changes before progressing to the next round.
RESULTS: As a result of working group feedback, the decision aid was divided into sections: before, during and after a visit to the surgeon. Across all rounds of user-testing, clinicians rated the resource 5.9/7 (SD = 1.0) for perceived usefulness, and 6.0/7 for perceived ease of use (SD = 0.8). Patients reported the decision aid was easy to understand, on average correctly answering 3.4/5 knowledge questions (SD = 1.2) about surgery for
sciatica. The grade reading score for the website was 9.0. Patients scored highly on preparation for decision-making (4.4/5, SD = 0.7), suggesting strong potential to empower patients. Interview feedback showed that patients and clinicians felt the decision aid would encourage question-asking and help patients reflect on personal values.
CONCLUSIONS: Clinicians found the decision aid acceptable, patients found it was easy to understand and both groups felt it would empower patients to actively engage in their care and come to an informed decision that aligned with personal values. Input from the working group and user-testing was crucial for ensuring that the decision aid met patient and clinician needs.
UNASSIGNED: Patients and clinicians contributed to prototype development via the working group.