冠心病患者健康行为决策辅助工具的构建研究

doi:10.3761/j.issn.1672-9234.2024.12.015

摘要/Abstract

摘要：

目的构建符合我国冠心病患者人群特点的健康行为决策辅助工具（patients decision-making aids，PDAs），为临床医务人员实施心血管健康行为医患共同决策提供参考。方法在Ottawa决策支持框架理论指导下，通过文献研究形成健康行为PDAs框架初稿；经9名冠心病治疗与护理领域专家的2轮咨询形成工具框架；通过专家小组会讨论提取工具信息内容及可选方案；通过技术接受模型评价工具对6例患者及4名家属进行用户测评，修订形成PDAs。结果第2轮专家函询一、二级项目协调系数分别为0.334、0.341（P<0.05）；用户测评结果显示，感知有用维度得分（4.9±0.3）分，感知易用维度得分（4.3±0.7）分，外部特征维度得分（4.8±0.4）分。最终形成冠心病患者健康行为决策辅助工具包括决策需求评估、心血管风险评估、信息支持、方案获益和风险、澄清个人价值观、决策辅助流程、工具信息、工具改进8项一级项目，33项二级项目，呈现形式包括彩色纸质版手册和电子版手册。结论冠心病患者健康行为PDAs具有科学性、适宜性，将最佳临床证据与患者价值观结合，为冠心病患者健康行为决策提供参考。

关键词: 冠心病, 健康行为, 患者决策辅助工具, 医患共同决策

Abstract:

Objective To construct a health behavior patients decision-making aids（PDAs）that suitable for coronary heart disease population in China，so as to provide a decision support for behavior transformation and promote shared decision-making between nurses and patients. Methods Under the guidance of the Ottawa Decision Support Framework，the PDAs preliminary draft was formulated after literature analysis. A PDAs framework was formed through two rounds consultation of nine experts with relevant background. PDAs were finally developed after expert group discussions and revision based on patient evaluation. Results Evidence integration forms tool preliminary draft. The second round of coordination coefficients（Kendall’s W） was 0.344 and 0.341（P<0.05） respectively. The PDAs was evaluated by technical acceptance model. The perceived usefulness was（4.9±0.3） points，perceived usability was（4.3±0.7） points，and external features was（4.8±0.4） points. The PDAs framework included eight primary items：decision need assessment，cardiovascular risk assessment，information support，benefits and risks analysis，clarification of personal values，decision support process，tool information，tool improvement. Besides，it included eight primary items，33 secondary items and presentation format included color paper manual and electronic manual. Conclusion The health behavior PDAs for coronary heart disease is scientific and practical. It combines the best clinical evidence with patient values，therefore，provides health behavior decision suggestions for coronary heart disease patients.

Key words: Coronary heart disease, Health behavior, Patient decision aids, Shared decision-making

陈曦, 胡欢婷, 黄丹丹, 陈海莲, 毛越, 金静芬. 冠心病患者健康行为决策辅助工具的构建研究[J]. 中华护理教育, 2024, 21(12): 1496-1503.

CHEN Xi, HU Huanting, HUANG Dandan, CHEN Hailian, MAO Yue, JIN Jingfen. Development of a coronary heart disease health behavior patient decision aids tool[J]. Chinese Journal of Nursing Education, 2024, 21(12): 1496-1503.

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