共享决策干预在终末期肾脏病患者透析治疗决策中的应用

段方见; 石钰; 谢勤; 雷蕾; 张建平; 罗春梅

doi:10.16016/j.2097-0927.202209216

您当前的位置：

首页 >

文章列表页 >

共享决策干预在终末期肾脏病患者透析治疗决策中的应用

临床医学 | 更新时间：2026-01-09

- 共享决策干预在终末期肾脏病患者透析治疗决策中的应用
- Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease
- 陆军军医大学学报 2022年44卷第21期页码：2217-2223
- 作者机构：
  
  1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院：骨科
  2.400037 重庆，陆军军医大学(第三军医大学)第二附属医院：肾内科
  3.400038 重庆，陆军军医大学(第三军医大学)：护理学院
  4.400038 重庆，陆军军医大学(第三军医大学)：第一附属医院肾内科
- 作者简介：
  
  [罗春梅，E-mail: luochunmei@tmmu.edu.cn LUO Chunmei, E-mail: luochunmei@tmmu.edu.cn
- 基金信息：
- DOI：10.16016/j.2097-0927.202209216
  中图分类号： R459.5;R473.5;R692.5
- 收稿：2022-09-23，
  
  修回：2022-10-05，
  
  纸质出版：2022-11-15
- 稿件说明：
移动端阅览
段方见, 石钰, 谢勤, 等. 共享决策干预在终末期肾脏病患者透析治疗决策中的应用[J]. 陆军军医大学学报, 2022,44(21):2217-2223.

Fangjian DUAN, Yu SHI, Qin XIE, et al. Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease[J]. Journal of Army Medical University, 2022, 44(21): 2217-2223.
段方见, 石钰, 谢勤, 等. 共享决策干预在终末期肾脏病患者透析治疗决策中的应用[J]. 陆军军医大学学报, 2022,44(21):2217-2223. DOI： 10.16016/j.2097-0927.202209216.

Fangjian DUAN, Yu SHI, Qin XIE, et al. Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease[J]. Journal of Army Medical University, 2022, 44(21): 2217-2223. DOI： 10.16016/j.2097-0927.202209216.

摘要

目的

评估共享决策(shared decision making，SDM)干预的有效性，以期提高终末期肾脏病患者透析决策质量。

方法

采用随机对照的研究设计，纳入2021年10-12月重庆市4所三甲医院的72例终末期肾脏病患者，按照区组随机方法分配至干预组(

=36)或对照组(

=36)。干预组接受护士使用患者决策辅助工具(patient decision aids，PDA)进行决策辅导的SDM干预，对照组接受常规透析前教育。研究对象在干预1周后填写决策冲突量表、治疗选择问卷、医院焦虑抑郁量表、决策准备量表，透析后3个月完成SF-36量表和决策后悔量表。主要结局指标为决策冲突量表评分，次要结局指标为治疗选择、焦虑抑郁评分、决策准备评分、生活质量评分和决策后悔评分。

结果

在干预1周后，干预组的决策冲突评分(

＜0.01)、焦虑评分(

=0.005)显著低于对照组，干预组决策准备评分显著高于对照组(

＜0.01)，干预组对透析治疗不确定的比例显著低于对照组(15.15%

34.29%

=0.026)。在透析后3个月，干预组的生活质量评分中生理总评分显著高于对照组(

=0.004)，决策后悔评分显著低于对照组(

=0.002)。

结论

SDM干预可有效减少终末期肾脏病患者的决策冲突和决策后悔，减轻焦虑水平，同时改善患者的决策准备和生理健康。

Abstract

Objective

To evaluate the effectiveness of shared decision-making (SDM) interventions to improve the quality of dialysis decision-making in patients with end-stage renal disease.

Methods

A randomized controlled was carried out in 72 patients with end-stage renal disease recruited between October 2021 and December 2021. The patients were randomly assigned into the intervention group (

=36) or the control group (

=36). The intervention group was given SDM interventions in which the nurses used patient decision aids (PDA) for decision-making counseling

while the control group was given routine pre-dialysis education. All patients received the surveys of Decision Conflict Scale

Treatment Choice Questionnaire

Hospital Anxiety and Depression Scale

and Decision Readiness Scale in 1 week after the intervention

and 36-Item

Short Form Health Survey (SF-36) and Decision Regret Scale in 3 months after dialysis. The primary endpoint indicator was the score of Decision Conflict Scale

and the secondary ones were treatment choice

and scores of anxiety and depression

decision readiness

quality of life

and decision regret.

Results

After 1 week of intervention

the scores of decision conflict (

0.01) and anxiety (

=0.005) were significantly lower

while that of decision preparation (

0.01) was obviously higher in the intervention group than the control group. The proportion of uncertainty to dialysis in the intervention group was significantly lower than that of the control group (15.15%

34.29%

=0.026). In 3 months after dialysis

the intervention group obtained statistically higher total physiological score (

=0.004) and lower decision regret score (

=0.002) when compared with the control group.

Conclusion

SDM interventions can effectively reduce decision conflict and decision regret

reduce anxiety level

and improve decision preparation and physiological health for the patients with end-stage renal disease.

关键词

Keywords

references

ZHANG L X, ZHAO M H, ZUO L, et al . China kidney disease network (CK-NET) 2015 annual data report[J ] . Kidney Int Suppl (2011), 2019, 9(1): e1-e81. DOI: 10.1016/j.kisu.2018.11.001.

MORTON R L, TONG A, HOWARD K, et al . The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies[J ] . BMJ, 2010, 340: c112. DOI: 10.1136/bmj.c112.

SHI Y, LI W, DUAN F J, et al . Factors promoting shared decision-making in renal replacement therapy for patients with end-stage kidney disease: systematic review and qualitative meta-synthesis[J ] . Int Urol Nephrol, 2022, 54(3): 553-574. DOI: 10.1007/s11255-021-02913-8.

COVIC A, BAMMENS B, LOBBEDEZ T, et al . Educating end-stage renal disease patients on dialysis modality selection: clinical advice from the European Renal Best Practice (ERBP) Advisory Board[J ] . Nephrol Dial Transplant, 2010, 25(6): 1757-1759. DOI: 10.1093/ndt/gfq206.

Hemodialysis Adequacy Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006[J]. A J Kidney Dis, 2006, 48(Suppl 1): S2-S90. DOI: 10.1053/j.ajkd.2006.03.051.

Peritoneal Dialysis Adequacy Work Group. Clinical practice guidelines for peritoneal dialysis adequacy[J]. Am J Kidney Dis, 2006, 48(Suppl 1): S98-S129. DOI: 10.1053/j.ajkd.2006.04.006.

CHEN N H, LIN Y P, LIANG S Y, et al . Conflict when making decisions about dialysis modality[J ] . J Clin Nurs, 2018, 27(1/2): e138-e146. DOI: 10.1111/jocn.13890.

STACEY D, LÉGARÉ F, LEWIS K, et al . Decision aids for people facing health treatment or screening decisions[J ] . Cochrane Database Syst Rev, 2017, 4(4): CD001431. DOI: 10.1002/14651858.CD001431.pub5.

PUN J K H, CHAN E A, WANG S, et al . Health professional-patient communication practices in East Asia: an integrative review of an emerging fiel d of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China[J ] . Patient Educ Couns, 2018, 101(7): 1193-1206. DOI: 10.1016/j.pec.2018.01.018.

ZHANG L X, WANG F, WANG L, et al . Prevalence of chronic kidney disease in China: a cross-sectional survey[J ] . Lancet, 2012, 379(9818): 815-822. DOI: 10.1016/S0140-6736(12)60033-6.

CHEN C H, KANG Y N, CHIU P Y, et al . Effectiveness of shared decision-making intervention in patients with lumbar degenerative diseases: a randomized controlled trial[J ] . Patient Educ Couns, 2021, 104(10): 2498-2504. DOI: 10.1016/j.pec.2021.03.002.

STACEY D, KRYWORUCHKO J, BENNETT C, et al . Decision coaching to prepare patients for making health decisions: a systematic review of decision coaching in trials of patient decision AIDS[J ] . Med Decis Making, 2012, 32(3): E22-E33. DOI: 10.1177/0272989X12443311.

SUBRAMANIAN L, ZHAO J H, ZEE J, et al . Use of a decision aid for patients considering peritoneal dialysis and in-center hemodialysis: a randomized controlled trial[J ] . Am J Kidney Dis, 2019, 74(3): 351-360. DOI: 10.1053/j.ajkd.2019.01.030.

牟玮, 陆翠, 王云云, 等. 患者决策辅助工具国际标准4.0版的引进与评估[J]. 医学与哲学, 2019, 40(18): 11-17. DOI: 10.12014/j.issn.1002-0772.2019.18.03.

MU W, LU C, WANG Y Y, et al . Cross-cultural adaptation and assessment of the international patient decision aids standards v4.0 for Chinese version[J ] . Med Philos A, 2019, 40(18): 11-17. DOI: 10.12014/j.issn.1002-0772.2019.18.03.

VOLK R J, LLEWELLYN-THOMAS H, STACEY D, et al . Ten years of the International Patient Decision Aid Standards Collaboration: evolution of the core dimensions for assessing the quality of patient decision aids[J ] . BMC Med Inform Decis Mak, 2013, 13(Suppl 2): S1. DOI: 10.1186/1472-6947-13-S2-S1.

ELWYN G, DURAND M A, SONG J L, et al . A three-talk model for shared decision making: multistage consultation process[J ] . BMJ, 2017, 359: j4891. DOI: 10.1136/bmj.j4891.

LAM W W T, KWOK M, LIAO Q Y, et al . Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery[J ] . Health Expect, 2015, 18(2): 210-220. DOI: 10.1111/hex.12021.

孙振晓, 刘化学, 焦林瑛, 等. 医院焦虑抑郁量表的信度及效度研究[J]. 中华临床医师杂志(电子版), 2017, 11(2): 198-201. DOI: 10.3877/cma.j.issn.1674-0785.2017.02.005.

SUN Z X, LIU H X, JIAO L Y, et al . Reliability and validity of hospital anxiety and depression scale[J ] . Chin J Clin Electron Ed, 2017, 11(2): 198-201. DOI: 10.3877/cma.j.issn.1674-0785.2017.02.005.

李玉. 早期原发性肝癌患者治疗决策辅助方案的构建与应用研究[D]. 上海: 第二军医大学, 2017.

LI Y. Construction and application of treatment decision aids for early-stage primary liver cancer patients[D]. Shanghai: Second Military Medical University, 2017.

罗纪聪, 赵景宏, 成琼, 等. 健康生命量表应用于自动化腹膜透析和持续非卧床腹膜透析患者生命质量评价的信效度研究[J]. 中国血液净化, 2020, 19(7): 445-448. DOI: 10.3969/j.issn.1671-4091.2020.07.004.

LUO J C, ZHAO J H, CHENG Q, et al . Reliability and validity of Chinese version of SF-36 scale for quality of life evaluation in automated peritoneal dialysis and continuous ambulatory peritoneal dialysis patients[J ] . Chin J Blood Purif, 2020, 19(7): 445-448. DOI: 10.3969/j.issn.1671-4091.2020.07.004.

陈芳, 程晓姣. 中文版决策后悔量表应用于面部美容受术者的信效度评价[J]. 护理学报, 2018, 25(7): 42-44. DOI: 10.16460/j.issn1008-9969.2018.07.042.

CHEN F, CHENG X J. Reliability and validity evaluation of Chinese version of Decision Regret Scale for facial cosmetic-surgery[J]. J Nurs China, 2018, 25(7): 42-44. DOI: 10.16460/j.issn1008-9969.2018.07.042.

HUANG C W, WEE P H, LOW L L, et al . Prevalence and risk factors for elevated anxiety symptoms and anxiety disorders in chronic kidney disease: a systematic review and meta-analysis[J ] . Gen Hosp Psychiatry, 2021, 69: 27-40. DOI: 10.1016/j.genhosppsych.2020.12.003.

PALMER S, VECCHIO M, CRAIG J C, et al . Prevalence of depression in chronic kidney disease: systematic review and meta-analysisof observational studies[J ] . Kidney Int, 2013, 84(1): 179-191. DOI: 10.1038/ki.2013.77.

TONG A, LESMANA B, JOHNSON D W, et al . The perspectives of adults living with peritoneal dialysis: thematic synthesis of qualitative studies[J ] . Am J Kidney Dis, 2013, 61(6): 873-888. DOI: 10.1053/j.ajkd.2012.08.045.

WALKER R, MARSHALL M R, MORTON R L, et al . The cost-effectiveness of contemporary home haemodialysis modalities compared with facility haemodialysis: a systematic review of full economic evaluations[J ] . Nephrology (Carlton), 2014, 19(8): 459-470. DOI: 10.1111/nep.12269.

REDDY Y N V, MENDU M L. The role of incremental peritoneal dialysis in the era of the advancing American kidney health initiative[J]. Clin J Am Soc Nephrol, 2020, 15(12): 1835-1837. DOI: 10.2215/CJN.03960320.

SARAN R, LI Y, ROBINSON B, et al . US renal data system 2014 annual data report: epidemiology of kidney disease in the United States[J ] . Am J Kidney Dis, 2015, 66(1 Suppl 1): Svii, S1-Svii, S305. DOI: 10.1053/j.ajkd.2015.05.001.

TAYLOR D M, FRASER S D S, BRADLEY J A, et al . A systematic review of the prevalence and associations of limited health literacy in CKD[J ] . Clin J Am Soc Nephrol, 2017, 12(7): 1070-1084. DOI: 10.2215/CJN.12921216.

DURAND M A, YEN R W, O'MALLEY A J, et al . What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata[J ] . Cancer, 2021, 127(3): 422-436. DOI: 10.1002/cncr.33248.

孙禾奇, 吕军, 叶建明, 等. 血液透析和腹膜透析技术对患者生活质量的影响分析[J]. 中国卫生事业管理, 2022, 39(7): 552-555.

SUN H Q, LYU J, YE J M, et al . Effect of hemodialysis and peritoneal dialysis on the quality of life of patients[J ] . Chin J Health Serv Manage, 2022, 39(7): 552-555.

KALA N TAR-ZADEH K, JAFAR T H, NITSCH D, et al . Chronickidney disease[J ] . Lancet, 2021, 398(10302): 786-802. DOI:10.1016/S0140-6736(21)00519-5.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

常规超声及三维斑点追踪成像技术对血液透析患者自体动静脉内瘘成熟的预测价值

单中心14年腹膜透析相关性腹膜炎病原菌谱变化趋势分析

骨髓间充质干细胞外泌体治疗改善高糖腹透液引起的小鼠腹膜纤维化

外周血NLR、NHR在终末期肾脏病患者颈动脉粥样硬化中的临床价值分析

分段枸橼酸抗凝在高出血风险患者透析中的临床疗效分析与个体化方案研究