Patient-Clinician Decision Making for Stable Angina: The Role of Health Literacy.

Samuel T Savitz, Claudia C Dobler, Nilay D Shah, Antonia V Bennett, Stacy Cooper Bailey, Stacie B Dusetzina, W Schuyler Jones, Sally C Stearns, Victor M Montori
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Abstract

Background: Stable angina patients have difficulty understanding the tradeoffs between treatment alternatives. In this analysis, we assessed treatment planning conversations for stable angina to determine whether inadequate health literacy acts as a barrier to communication that may partially explain this difficulty.

Methods: We conducted a descriptive analysis of patient questionnaire data from the PCI Choice Trial. The main outcomes were the responses to the Decisional Conflict Scale and the proportion of correct responses to knowledge questions about stable angina. We also conducted a qualitative analysis on recordings of patient-clinician discussions about treatment planning. The recordings were coded with the OPTION12 instrument for shared decision-making. Two analysts independently assessed the number and types of patient questions and expressions of preferences.

Results: Patient engagement did not differ by health literacy level and was generally low for all patients with respect to OPTION12 scores and the number of questions related to clinical aspects of treatment. Patients with inadequate health literacy had significantly higher decisional conflict. However, the proportion of knowledge questions answered correctly did not differ significantly by health literacy level.

Conclusions: Patients with inadequate health literacy had greater decisional conflict but no difference in knowledge compared to patients with adequate health literacy. Inadequate health literacy may act as a barrier to communication, but gaps were found in patient engagement and knowledge for patients of all health literacy levels. The recorded patient-clinician encounters and the health literacy measure were valuable resources for conducting research on care delivery.

稳定型心绞痛的临床决策:健康素养的作用
背景:稳定型心绞痛患者很难理解治疗方案之间的权衡。在本分析中,我们评估了稳定型心绞痛的治疗计划对话,以确定健康素养不足是否成为沟通的障碍,这可能部分解释了这种困难。方法:我们对PCI选择试验的患者问卷数据进行了描述性分析。主要结果为对决策冲突量表的回答和对稳定型心绞痛知识问题的正确回答比例。我们还对医患讨论治疗计划的录音进行了定性分析。录音用OPTION12工具编码,以便共同决策。两名分析师独立评估了患者问题的数量和类型以及偏好的表达。结果:患者参与没有因健康素养水平而异,所有患者在OPTION12评分和与治疗临床方面相关的问题数量方面普遍较低。健康素养不足的患者有更高的决策冲突。然而,正确回答知识问题的比例在健康素养水平上没有显著差异。结论:健康素养不足的患者与健康素养充足的患者相比,存在更大的决策冲突,但在知识方面没有差异。卫生知识不足可能成为沟通的障碍,但在所有卫生知识水平的患者的参与和知识方面发现了差距。记录的患者与临床医生的接触和健康素养测量是开展护理提供研究的宝贵资源。
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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