摘要
目的制订终末期肾脏病患者透析决策辅助方案并探讨其应用效果。方法以3步谈话模式为理论指导,在汉化翻译相关工具及文献检索分析的基础上,初步构建终末期肾脏病患者透析决策辅助方案,并经2轮专家函询及预试验后形成最终版决策辅助方案。最终方案包括《终末期肾脏病患者透析决策辅助手册》及《终末期肾脏病决策辅助手册(医护专用版)》,后者包含不同阶段透析辅助决策谈话方案及决策辅助方案实施流程。并以2018年11月至2019年10月在上海交通大学医学院附属仁济医院肾内科门诊规律随访且初次面临透析方案选择的终末期肾脏病患者作为研究对象,验证该决策辅助方案的实施效果。以2018年11月至2019年4月就诊的49例患者作为对照组,实施常规随访;以2019年5—10月收治的49例患者作为观察组,在常规随访的基础上实施透析前决策辅助方案。采用透析决策知识问卷和决策冲突量表对实施效果进行评价。结果干预后,观察组患者对透析决策知识的掌握情况优于对照组(P<0.05),且决策冲突水平低于对照组(P<0.05)。结论终末期肾脏病患者透析决策辅助方案可帮助医护人员规范实施患者教育,有效提高患者透析选择的相关知识水平、降低决策冲突,有利于提升患者满意度、促进治疗收益最大化。
Objective To develop a dialysis decision aid and explore its application in decision-making among patients with end-stage renal disease.Methods Based on relevant Chinese translation tools and literature retrieval and analysis,a dialysis decision aid for patients with end-stage renal disease was preliminarily constructed using a three-talk model interview as theoretical guidance.Then,a final decision aid was formed after 2 rounds of expert consultation and pre-test.The final decision aid included the content of the Dialysis Decision Aid Booklet for Patients with End-stage Renal Disease and the Decision Aid Booklet for End-stage Renal Disease(For Medical Care Only).The latter contained interview plans and implementation processes at different stages of the dialysis decision aid.In order to validate the effect of the decision aid,patients with end-stage renal disease were selected as subjects,who were regularly followed up at the Nephrology Department of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2018 to October 2019 and had to select dialysis regimens for the first time.A total of 49 patients who visited the hospital from November 2018 to April 2019 were included in the control group to receive routine follow-up;another 49 patients who visited the hospital from May to October 2019 were included in the observation group to receive pre-dialysis decision aid on this basis.The Dialysis Decision Knowledge Questionnaire and Decisional Conflict Scale were used to evaluate the implementation effect of the decision aid.Results After the intervention,the patients in the observation group had better knowledge of dialysis decision-making than those in the control group(P<0.05),and the level of decisional conflict was lower than that in the control group(P<0.05).Conclusion Dialysis decision aid for patients with end-stage renal disease can help medical staff to standardize the implementation of patient education,increase patient knowledge to select dialysis regimens,reduce decisi
作者
查丹凤
杨艳
杨雄豪
章海芬
金艳
李娜
ZHA Danfeng;YANG Yan;YANG Xionghao;ZHANG Haifen;JIN Yan;LI Na(Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127;Shanghai Jiao Tong University School of Nursing,Shanghai 200025;Yangpu Hospital Affiliated to Tongji University,Shanghai 200090)
出处
《上海护理》
2021年第10期23-28,共6页
Shanghai Nursing
基金
上海交通大学中国医院发展研究院2019年度医院管理建设项目(CHDI-2019-B-10)。
关键词
终末期肾脏病
决策辅助
决策
透析
End-stage renal disease
Decision aid
Decision-making
Dialysis
