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Associated factors of shared decision making preference in patients with coronary artery disease
shared decision making,autonomy preference index,control preference scale,patients’ preference of decision making,information seeking,
|Publication Year :||2017|
本研究以自主偏好問卷(the autonomy preference index)、控制偏好量表(control preference scale)針對彰化基督教醫院之冠狀動脈疾病患者，做為評估病患參與醫療決策意願之工具，另外以決策品質問卷(Decisional quality instrument)中的部分項目以及基本資料作為變數，有效問卷數目為，以STATA 14作為統計分析工具。
In contrast to the traditional doctor-patient relationship based on paternalism, shared decision-making was popular decision-making strategies in recent years globally. The purpose of shared decision-making is to include mainly the physician and the patient in decision-making process, in which the physician shares the available evidence to the patient, the patient is informed, and then the decision is facilitated accordingly. Around A.D. 1980, there were some studies investigating patients’ willingness to participate in the medical decision-making process. Charles et al. first developed the theoretical framework of shared decision-making in 1997, and thereafter, the decision aids were developed for shared decision-making. Since 2016, the government of Taiwan has been promoting the strategies of shared decision-making. However, few studies have been focused on patients’ willingness to participate in clinical decision-making process in an East Asian society in which family determination is usually honored. The objective of this study was to investigate the patient’s preferences about participating in medical decision-making process.
This was a cross-sectional study conducted in a medical center located at Changhua, Taiwan in 2017. We invited the patients consecutively admitted with coronary artery disease from June 2, 2017 to August 8, 2017 to participate in this study. All participants were required to complete the questionnaires of “the autonomy preference index” and “control preference scale”, all of which investigates participants’ willingness to participate in medical decision-making. We also collected the demographic characteristics as the confounding variables. The linear relationship between two continuous variables, and between a continuous variable and a categorical variable were examined using Pearson’s correlation coefficient and Spearman’s rank correlation coefficient, respectively. Multivariate linear regression analysis was used to examine the relationship between an independent variable of interest and the shared decision-making preferences. All statistical analyses were carried out using STATA 14.0 MP for Windows PC.
A total of 104 patients participated in this study and completed the questionnaires. The decision-making preference score was 51.96±11.52 (a score range of 0-100) in the autonomy preference index which showed the patients’ willingness to actively participate in the decision-making process. By the questionnaire of control preference scale, 58.65% of the participants preferred to participate actively in the decision-making process, and 21.15% of them preferred to make medical decision solely by self. Older (p=0.02) and male (p=0.01) participants were reluctant to participate in the decision-making process as compared to younger and female participants, respectively. Similar findings were identified in the participants with the educational level of junior high school or lower(p=0.16). Otherwise, the preferences of the participants with severe clinical illnesses to participate in decision-making declined, particularly in the male group.
According to the study results, a majority of the participants favored shared decision-making, and thus, it is appropriate to promote shared decision-making in Taiwan. Nevertheless, it is important to promote shared decision-making by educating both physicians and patients. Future studies may be focused on investigating the factors associated with patients’ preferences for decision-making. If patients declined to be included in the decision-making process, their preferences should be respected. The decision-making may be facilitated by consulting the surrogate of the patient.
|Appears in Collections:||醫學教育暨生醫倫理學科所|
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