将临床推理整合到患者决策辅助中,帮助人们做出保守的肾脏管理和透析决策:以用户为中心的干预开发设计

IF 3.4 Q1 UROLOGY & NEPHROLOGY
Anna Winterbottom , Andrew Mooney , Lynne Russon , Vicki Hipkiss , Lucy Ziegler , Jeanette Finderup , Richard Williams , Hilary L. Bekker
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引用次数: 0

摘要

基本原理及目的对于老年肾衰竭患者,保守的肾脏管理可以提供更好的生活质量,更少的治疗负担,对一些人来说,可以获得相同的生命长度。患者围绕肾脏治疗的决策是复杂的,对患者和卫生专业人员都是情感上的要求。肾脏单位提供的关于透析和保守的肾脏管理方案的资源往往不足以支持人们在方案之间做出合理的决定。本文描述了支持约克郡透析和保守护理决策辅助发展的2项研究。研究设计研究1:采用深度访谈法的横断面研究;研究2:以用户为中心的多利益相关者迭代设计。设置,参与者来自英格兰北部3个肾脏单位的肾衰竭成人和健康专业人员。资源开发包括来自联合王国和丹麦的共同申请人、患者和公众参与小组、多学科卫生专业人员和学者的投入。分析方法采用专题分析方法对数据进行分析。结果三个主题综合了利益相关者的反应:向保守肾脏管理途径的过渡,改变肾脏护理管理的临床和社会指标,以及临终关怀的准备。研究结果为患者决策辅助内容提供了依据国际指南构建的信息。患者决策辅助系统进行了16次迭代,解决了多个利益相关者的评估问题。肾衰竭患者、家庭成员和肾脏专业人员一致认为,最终资源提供了准确、平衡、可获取和相关的信息,支持他们在日常生活中选择保守肾管理护理还是透析。样本中缺乏种族多样性。结论肾衰竭患者在制定肾脏护理计划时必须在透析和保守肾管理之间做出选择。该资源的开发使用了专业人员对肾脏疾病管理的临床推理的证据。提供支持患者决策援助开发的研究细节,说明为什么该资源可以提高健康素养,并支持与做出这些困难决定的人进行共同决策对话。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Integrating Clinical Reasoning Into a Patient Decision Aid for People Making Conservative Kidney Management and Dialysis Decisions: A User-Centered Intervention Development Design

Rationale & Objective

For older adults with kidney failure, conservative kidney management can provide better quality of life, less treatment burden, and for some, the same length of life benefit. Patient decision making around kidney treatments is complex and emotionally demanding for both patients and health professionals. Resources provided by kidney units about dialysis and conservative kidney management options are frequently not sufficient to support people making reasoned decisions between options. This article describes 2 studies underpinning the development of the Yorkshire Dialysis and Conservative Care Decision Aid.

Study Design

Study 1: cross-sectional study using in-depth interview methods; study 2: user-centered iterative design with multiple stakeholders.

Setting & Participants

Older adults with kidney failure and health professionals from 3 kidney units in the North of England. Resource development included input from co-applicants, patient and public involvement team, multidisciplinary health professionals, and academics in the United Kingdom and Denmark.

Analytical Approach

Thematic analysis was used to analyze the data.

Results

Three themes synthesized stakeholder responses: transition to a conservative kidney management pathway, clinical and social indicators for changing kidney care management, and preparation for end-of-life care. The findings informed the patient decision aid content, which was structured with reference to international guidance. There were 16 iterations of the patient decision aid addressing multiple-stakeholder evaluations. People with kidney failure, family members, and kidney professionals agreed the final resource provides accurate, balanced, accessible, and relevant information supporting engagement with the decision between conservative kidney management care and dialysis within the kidney care pathway in the context of their everyday life.

Limitations

There was a lack of ethnic diversity in the sample.

Conclusions

People with kidney failure must choose between dialysis and conservative kidney management when planning their kidney care. Development of this resource used evidence of professionals’ clinical reasoning about kidney disease management. Providing details of the research underpinning patient decision aid development demonstrates why the resource can enhance health literacy and supports shared decision making conversations with people making these difficult decisions.
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来源期刊
Kidney Medicine
Kidney Medicine Medicine-Internal Medicine
CiteScore
4.80
自引率
5.10%
发文量
176
审稿时长
12 weeks
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