Characterizing Decisional Conflict in Patients Presenting to Sleep Surgery Clinic and an Exploration of Resource Limitations.

The Laryngoscope Pub Date : 2021-10-01 Epub Date: 2021-06-21 DOI:10.1002/lary.29695
Arushi Gulati, Erika M Stephens, Yi Cai, Jolie L Chang
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引用次数: 4

Abstract

Objectives: Numerous therapies exist for adult obstructive sleep apnea (OSA), creating potential for patient decisional conflict (DC) that impacts treatment adherence and post-treatment regret. We evaluated the prevalence of elevated DC in OSA patients presenting for positive airway pressure (PAP) alternative therapies and identified gaps in available resources about OSA therapies.

Study design: Cross-sectional study.

Methods: A cross-sectional study was performed based on questionnaires completed by adult OSA patients presenting to an academic sleep surgery clinic from March to October 2020. Surveys examined sleep symptoms, sleep apnea treatment history, goals of therapy, and the SURE checklist, a validated 4-item DC screening scale. Additional qualitative data about OSA decision tool needs were queried with structured interviews in a smaller subset of patients.

Results: Among 100 respondents, 60 were open to multiple treatment options, whereas 22 were not interested in surgical treatment. Eighty-one respondents (81%) had elevated DC (SURE score < 4). High DC was not associated with CPAP history, OSA severity, or daytime sleepiness (Epworth Sleepiness Scale score ≥ 10). Elevated DC was related to uncertainty regarding optimal treatment choice in 54% of respondents (n = 54), and lack of knowledge regarding risks and benefits of each treatment option in 71% (n = 71). Common themes identified in 9 interviewed patients suggested helpful resources should ideally compare treatment modalities and educate on surgery details, efficacy, and recovery.

Conclusions: The majority of OSA patients presenting to sleep surgery clinics have elevated decisional conflict influenced by limited knowledge about options and the risks and benefits of each therapy. There is a need for decision tools that can reduce decisional conflict and promote equitable knowledge about PAP alternative OSA treatments.

Level of evidence: 4 Laryngoscope, 131:2384-2390, 2021.

睡眠外科门诊患者的决策冲突特征及资源限制探讨。
目的:成人阻塞性睡眠呼吸暂停(OSA)有多种治疗方法,这可能会导致患者决策冲突(DC),影响治疗依从性和治疗后后悔。我们评估了接受气道正压(PAP)替代治疗的OSA患者中DC升高的患病率,并确定了OSA治疗的可用资源缺口。研究设计:横断面研究。方法:对2020年3月至10月在学术睡眠外科诊所就诊的成年OSA患者完成的问卷进行横断面研究。调查包括睡眠症状、睡眠呼吸暂停治疗史、治疗目标和SURE检查表(一个经过验证的4项DC筛查量表)。对一小部分患者进行结构化访谈,询问有关OSA决策工具需求的其他定性数据。结果:100名受访者中,60人对多种治疗方案持开放态度,22人对手术治疗不感兴趣。81名受访者(81%)的DC (SURE)评分升高。结论:大多数到睡眠手术诊所就诊的OSA患者,由于对每种治疗方案的风险和益处的了解有限,他们的决策冲突升高。需要决策工具来减少决策冲突,促进PAP替代OSA治疗的公平知识。证据水平:4喉镜,131:2384- 2390,2021。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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