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目的：探讨医患共同决策在前列腺癌患者的全程管理中对患者疾病认知水平、满意度及治疗依从意向的影响，揭示医患双方随共同决策实施频次增加的学习曲线特征。方法：采用非随机前后测干预研究结合访谈，在40例前列腺癌患者和4名医生中进行，根据决策期望量表评估结果将患者分为观察组与对照组，每组各20例患者，每组随机1名高年资医师和1名低年资医师，观察组采取共同决策诊疗模式，对照组采取传统诊疗模式。评估两组患者中心结局及医生技能的学习曲线。结果：共同决策诊疗改善了患者满意度(P<0.001)和并提升了疾病相关知识水平(P<0.001)，但未显著影响治疗依从意愿。同时共同诊疗决策缩短了沟通时间(P=0.003)，学习曲线提示随着共同决策诊疗的次数增多，SDM实施意愿随之提升，但高年资医生和低年资医生的变化趋势存在差异。结论：共同决策诊疗模式使患者获益，并能减轻医生负担。未来应该注重政策保障、分层培训、优化工具设计，以促进其在临床中的有效实施和持续发展。
Abstract：Objective: To explore the impact of shared decision-making(SDM) on disease knowledge level, satisfaction, and treatment adherence intention of patients with prostate cancer during whole-course management, and to reveal the learning curve characteristics of both patients and physicians as the frequency of SDM implementation increases. Methods: A non-randomized pretest-posttest intervention study combined with interviews was conducted among 40 patients with prostate cancer and 4 physicians. Patients were divided into an observation group and a control group(20 patients in each group) based on the results of the Decision Expectation Scale. Each group was randomly assigned 1 senior physician and 1 junior physician. The observation group adopted the SDM model, while the control group used the traditional diagnosis and treatment model. The patient-centered outcomes of the two groups and the learning curves of physicians' skills were evaluated. Results: The SDM model improved patients' satisfaction(P<0.001) and increased disease-related knowledge level(P<0.001), but had no significant impact on treatment adherence intention. Meanwhile, SDM shortened the communication time(P=0.003). The learning curve showed that as the number of SDM implementations increased, the willingness to implement SDM also increased, but there were differences in the change trends between senior and junior physicians. Conclusion: The SDM model benefits patients and reduces physicians' burden. In the future, attention should be paid to policy support, hierarchical training, and optimization of decision aid tool design to promote its effective implementation and sustainable development in clinical practice.
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基本信息:
DOI：10.19558/j.cnki.10-1020/r.2025.04.010
中图分类号:R737.25
引用信息:
[1]杜慧娟,王保军,李娟,等.前列腺癌全程管理中的共同决策：改善患者结局和医生技能的学习曲线分析[J].微创泌尿外科杂志,2025,14(04):269-276.DOI:10.19558/j.cnki.10-1020/r.2025.04.010.