PEC innovation最新文献_第5页

Clinician-patient communication about cancer treatment misinformation: The Misinformation Response Model 关于癌症治疗误导的医患沟通：错误信息应对模式

PEC innovation

Pub Date : 2024-07-06 DOI: 10.1016/j.pecinn.2024.100319

M. Devyn Mullis , Carla L. Fisher , Skyler B. Johnson , Tianshi Liu , Tithi B. Amin , Sherise Rogers , Kennan DeGruccio , Carma L. Bylund

Objective

Cancer treatment misinformation (CTM) is pervasive and impacts patient health outcomes. Cancer clinicians play an essential role in addressing CTM. We previously identified four self-reported responses that characterize the communication process clinicians engage in to address CTM. Clinicians 1) work to understand the misinformation; 2) correct the misinformation through education; 3) advise about future online searches; and 4) preserve the clinician-patient relationship. We sought to confirm and expand on the model we developed by observing cancer clinicians' communication while addressing CTM with a standardized patient (SP).

Methods

17 cancer clinicians were audio recorded in a SP encounter, in which a breast cancer SP asked three questions based on CTM. We thematically analyzed transcriptions of the recordings.

Results

Clinicians used four responses with associated strategies and skills to address CTM in a standardized clinical encounter, confirming the previously developed model. The four responses were: (1) work to understand the misinformation; (2) correct the misinformation through education; (3) advise about future online searches; and (4) preserve the clinician-patient relationship. This observational approach allowed us to refine strategies within each response and identify communication skills clinicians enact to address CTM.

Conclusion

These findings provide a strong foundation for the Misinformation Response Model for cancer clinicians. Future research should examine which components of the model are most effective in improving patient outcomes.

Innovation

This is the first study observing clinicians' communication through simulated practice with SPs about CTM.

目标癌症治疗误导信息（CTM）普遍存在并影响患者的健康结果。癌症临床医生在应对 CTM 方面发挥着至关重要的作用。我们先前确定了临床医生为解决 CTM 而参与的沟通过程中的四种自我报告反应。临床医生：1）努力了解错误信息；2）通过教育纠正错误信息；3）就未来的在线搜索提供建议；以及 4）维护临床医生与患者之间的关系。我们试图通过观察癌症临床医生在与标准化患者（SP）讨论 CTM 时的交流情况来证实并扩展我们开发的模型。方法：我们对 17 名癌症临床医生在 SP 会诊中的谈话进行了录音，其中一名乳腺癌 SP 根据 CTM 提出了三个问题。我们对录音转录进行了专题分析。结果临床医生在标准化临床会诊中使用了四种反应及相关策略和技巧来应对 CTM，证实了之前开发的模型。这四种应对方法是(1) 努力了解错误信息；(2) 通过教育纠正错误信息；(3) 就未来的在线搜索提供建议；(4) 维护临床医生与患者之间的关系。这些发现为癌症临床医生的错误信息应对模式奠定了坚实的基础。未来的研究应探讨该模型的哪些部分对改善患者预后最有效。创新这是第一项通过模拟实践观察临床医生与 SPs 就 CTM 进行沟通的研究。

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引用次数: 0

The effects of telepresence with real-time video and audio communication on parent-infant interaction and staff experience in neonatal intensive care unit 在新生儿重症监护室中，实时视频和音频通信的远程呈现对父母与婴儿互动和工作人员体验的影响

PEC innovation

Pub Date : 2024-07-05 DOI: 10.1016/j.pecinn.2024.100315

Tomoko Saito , Tomoyuki Shimokaze , Miku Niizuma , Masako Suzuki , Makiko Toyoshima , Katsuaki Toyoshima

Objective

We implemented an online visitation system named “telepresence” in the neonatal intensive care unit (NICU) for family members at home to communicate with their babies in real-time using video and audio. This study evaluated the impact of this system on families and medical staff.

Methods

Nineteen families of babies admitted to the NICU between 2022 and 2023 and 65 medical staff participated. Each family experienced two weeks of virtual visits. Changes in parental depression and attachment were assessed.

Result

Before and after telepresence, the median Edinburgh Postnatal Depression Scale score reduced from 6 to 4 (p = 0.026), and the Mother-to-Infant Bonding Scale score showed a decreasing trend, with both medians at 2 (p = 0.057). Eighty-nine percent of the parents and 97% of staff reported that telepresence did not increase parental stress, and 88% of parents felt positive changes in their baby's siblings. All parents wanted to visit their babies in person after seeing them on camera.

Conclusion

Telepresence improved parental mental health, reduced family distress, and supported connection with their infants, making them eager to visit in person.

Innovations

This technology potentially make parents want to visit more by helping them feel more connected to their infants.

目的我们在新生儿重症监护室（NICU）实施了一个名为 "远程呈现 "的在线探视系统，让家中的家庭成员可以通过视频和音频与婴儿进行实时交流。这项研究评估了这一系统对家属和医务人员的影响。方法2022 年至 2023 年期间，19 个新生儿重症监护室的婴儿家属和 65 名医务人员参与了这项研究。每个家庭都经历了两周的虚拟探访。结果在远程呈现之前和之后，爱丁堡产后抑郁量表的中位数从 6 分降至 4 分（p = 0.026），母婴结合量表的得分呈下降趋势，中位数均为 2 分（p = 0.057）。89% 的家长和 97% 的工作人员表示，远程呈现没有增加家长的压力，88% 的家长感觉到婴儿的兄弟姐妹有了积极的变化。结论远程呈现改善了父母的心理健康，减少了家庭的痛苦，支持了他们与婴儿的联系，使他们渴望亲自探望婴儿。创新之处这项技术通过帮助父母感受到与婴儿的更多联系，有可能使他们更愿意探望婴儿。

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引用次数: 0

Awareness of antimicrobial resistance and appropriate handling of antibiotics by the public in Saudi Arabia: A cross-sectional study using a quiz game 沙特阿拉伯公众对抗菌药耐药性的认识和抗生素的正确使用：利用问答游戏进行的横断面研究

PEC innovation

Pub Date : 2024-07-04 DOI: 10.1016/j.pecinn.2024.100318

Waad M. Alzahrani , Lujain S. Alkliakh , Esraa B. Alwafai , Manal F. Madani , Nima L. Hersi , Eilaaf A. Shakir , Abrar K. Thabit

Objective

Public awareness of antimicrobial resistance (AMR) is essential to tackling this issue. Studies in Saudi Arabia have demonstrated insufficient AMR knowledge among the public. We aimed to indirectly raise awareness while simultaneously assessing the public's knowledge. We also assessed the factors associated with optimal knowledge and antibiotic handling.

Methods

We developed an online quiz game comprising 10 questions on AMR knowledge and antibiotic handling, recording each participant's score. We collected the responses from the Saudi public using a cross-sectional study design.

Results

Of the 428 participants, 68.7% were females and 42.5% were aged between 41 and 65 years; 70.1% held undergraduate degrees. Only 17.8% had a health-related major. While 83.2% had heard of AMR, the median [interquartile range] AMR knowledge score was 6 [5–7] out of 10 points. Holding a health-related major and having prior knowledge of AMR were associated with higher scores (RR, 1.28 and 1.18; 95%CI, 1.13–1.44 and 1.03–1.35; P < 0.001 and P = 0.020, respectively).

Conclusion

The Saudi public demonstrated average knowledge of AMR. We recommend awareness-raising campaigns about AMR targeting the public.

Innovation

We utilized an innovative approach by distributing an online questionnaire as a quiz game to fulfill two purposes: the assessment of knowledge and awareness-raising about AMR.

目标公众对抗菌药耐药性（AMR）的认识对于解决这一问题至关重要。沙特阿拉伯的研究表明，公众对 AMR 的认识不足。我们的目的是在评估公众知识的同时间接提高公众的认识。我们开发了一个在线问答游戏，包含 10 个有关 AMR 知识和抗生素使用的问题，并记录了每位参与者的得分。结果在 428 名参与者中，68.7% 为女性，42.5% 年龄在 41 岁至 65 岁之间；70.1% 拥有本科学历。只有 17.8% 的人主修与健康相关的专业。虽然 83.2% 的人听说过 AMR，但 AMR 知识的中位数[四分位数间距]为 6 [5-7]分（满分 10 分）。拥有健康相关专业和事先了解 AMR 与较高的得分相关（RR，1.28 和 1.18；95%CI，1.13-1.44 和 1.03-1.35；P < 0.001 和 P = 0.020）。我们采用了一种创新方法，以问答游戏的形式分发在线问卷，以实现两个目的：知识评估和提高对 AMR 的认识。

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引用次数: 0

Palliative, hospice, and end-of-life care special issue introductory editorial 姑息治疗、安宁疗护和临终关怀特刊导读社论

PEC innovation

Pub Date : 2024-07-04 DOI: 10.1016/j.pecinn.2024.100314

Emily L. Mroz , Jordan M. Alpert

引用次数: 0

Feasibility and acceptability of a videoconference-based cognitive-behavioral intervention for caregivers of individuals living with mild cognitive impairment or early Alzheimer's disease 为轻度认知障碍或早期阿尔茨海默氏症患者的护理人员提供基于视频会议的认知行为干预的可行性和可接受性

PEC innovation

Pub Date : 2024-07-04 DOI: 10.1016/j.pecinn.2024.100317

Phylicia Verreault , Marie-Christine Ouellet , Céline Mavounza , Robert Jr Laforce , Jean Vézina , Carol Hudon

Objective

The objective of the current pilot study was to investigate the feasibility and acceptability of a videoconference-based cognitive behavioral (CBT) intervention for caregivers of individuals living with mild cognitive impairment or early Alzheimer's disease. The intervention included psychoeducation on emotions, strategies for management of unhelpful emotions and thoughts, behavioral activation, breathing and relaxation, strategies for communication and information on external resources.

Methods

This study used a cross-sectional design with two groups of four caregivers who received an 8-week CBT-based intervention via videoconference. Measures of feasibility and acceptability were collected post-intervention as well as suggestions for improvements.

Results

Eight female caregivers were enrolled in the intervention, one participant opted out at the seventh session. Of those who completed the program, all participants reported that it was very easy to participate using the online modality. All participants felt that the intervention was at least partly adapted to their experience and needs as a caregiver. Five out of seven participants (71%) indicated that they felt better and would recommend the intervention to another caregiver.

Conclusion

The current study demonstrated that it is feasible and acceptable to use a videoconference CBT-based group intervention with MCI or mild AD female caregivers.

Innovation

This is the first videoconference-based cognitive behavioral intervention for caregivers of individuals living with MCI or mild AD.

本试验性研究的目的是调查基于视频会议的认知行为（CBT）干预的可行性和可接受性，对象是轻度认知障碍患者或早期阿尔茨海默氏症患者的照顾者。干预内容包括情绪心理教育、无益情绪和想法管理策略、行为激活、呼吸和放松、沟通策略以及外部资源信息。方法本研究采用横断面设计，两组共四名照顾者通过视频会议接受了为期 8 周的 CBT 干预。干预结束后收集了可行性和可接受性的测量结果以及改进建议。在完成项目的参与者中，所有参与者都表示使用在线方式参与非常容易。所有参与者都认为，干预措施至少部分适应了她们作为照顾者的经验和需求。七名参与者中有五名（71%）表示他们感觉更好，并会向其他照顾者推荐该干预措施。创新这是首个针对 MCI 或轻度 AD 患者照顾者的基于视频会议的认知行为干预措施。

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引用次数: 0

Does empathy decline in the clinical phase of medical education? A study of students at Leicester medical school 移情能力在医学教育的临床阶段会下降吗？对莱斯特医学院学生的研究

PEC innovation

Pub Date : 2024-07-02 DOI: 10.1016/j.pecinn.2024.100316

Leila Keshtkar , Andy Ward , Rachel Winter , Char Leung , Jeremy Howick

Objective

To examine whether medical student empathy changes throughout the five years of a UK medical school.

Methods

Students completed an online version of the Jefferson Scale of Empathy (JSE-S) during the 2022–2023 academic year. Comparisons of empathy scores were made using analysis of variance (ANOVA), and independent t-tests.

Results

Empathy scores varied across different years of medical school (P ≤ 0.001), with a small drop in empathy between the pre-clinical and clinical phases of medical school (Mean difference = 1.82, P = 0.025). Male students scored lower than female students and there was no statistically significant difference between the mean empathy score and speciality interest.

Conclusions

Students' empathy appeared declined slightly as they progressed through medical school. As a crucial component of good clinical care, interventions in medical education to enhance empathy should be prioritised.

Innovation

This is the first time following the COVID-19 pandemic that medical student empathy was measured across all five years of a medical school. Unlike many previous related studies, we identified the point at which empathy appears to decline, providing guidance for educators who can target empathy enhancing interventions where they are most needed.

方法学生们在2022-2023学年完成了在线版杰斐逊移情量表（JSE-S）。结果同理心得分在医学院不同年级之间存在差异（P≤0.001），医学院临床前和临床阶段的同理心得分略有下降（平均差=1.82，P=0.025）。男生的同理心得分低于女生，平均同理心得分与专业兴趣之间没有统计学意义上的显著差异。作为良好临床护理的重要组成部分，应优先考虑在医学教育中采取干预措施以提高移情能力。创新这是 COVID-19 大流行后首次对医学院校五年级医学生的移情能力进行测量。与以往许多相关研究不同的是，我们确定了移情出现下降的时间点，为教育者提供了指导，使他们能够在最需要的地方有针对性地采取增强移情的干预措施。

{"title":"Does empathy decline in the clinical phase of medical education? A study of students at Leicester medical school","authors":"Leila Keshtkar , Andy Ward , Rachel Winter , Char Leung , Jeremy Howick","doi":"10.1016/j.pecinn.2024.100316","DOIUrl":"https://doi.org/10.1016/j.pecinn.2024.100316","url":null,"abstract":"<div><h3>Objective</h3><p>To examine whether medical student empathy changes throughout the five years of a UK medical school.</p></div><div><h3>Methods</h3><p>Students completed an online version of the Jefferson Scale of Empathy (JSE-S) during the 2022–2023 academic year. Comparisons of empathy scores were made using analysis of variance (ANOVA), and independent <em>t</em>-tests.</p></div><div><h3>Results</h3><p>Empathy scores varied across different years of medical school (<em>P</em> ≤ 0.001), with a small drop in empathy between the pre-clinical and clinical phases of medical school (Mean difference = 1.82, <em>P</em> = 0.025). Male students scored lower than female students and there was no statistically significant difference between the mean empathy score and speciality interest.</p></div><div><h3>Conclusions</h3><p>Students' empathy appeared declined slightly as they progressed through medical school. As a crucial component of good clinical care, interventions in medical education to enhance empathy should be prioritised.</p></div><div><h3>Innovation</h3><p>This is the first time following the COVID-19 pandemic that medical student empathy was measured across all five years of a medical school. Unlike many previous related studies, we identified the point at which empathy appears to decline, providing guidance for educators who can target empathy enhancing interventions where they are most needed.</p></div>","PeriodicalId":74407,"journal":{"name":"PEC innovation","volume":"5 ","pages":"Article 100316"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772628224000645/pdfft?md5=816af771b0520b2cb297a4a716cbc7d5&pid=1-s2.0-S2772628224000645-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring perceptions of online calculators for identifying community-dwelling older people at risk of dying: A qualitative study 探索对用于识别社区居住的面临死亡风险的老年人的在线计算器的看法：定性研究

PEC innovation

Pub Date : 2024-06-25 DOI: 10.1016/j.pecinn.2024.100313

Carol Bennett , Sarah Beach , Karen Pacheco , Amy T. Hsu , Peter Tanuseputro , Douglas G. Manuel

Objectives

This study aimed to assess the acceptability, value, and perceived barriers of using electronic risk calculators for predicting and communicating the risk of death in community-dwelling older adults.

Methods

One focus group and eight interviews were conducted with 16 participants with experience caring for patients or family members at end of life. A prototype mortality risk tool was used to anchor discussions. Data were analysed using a qualitative content analysis approach.

Results

Five themes emerged: acceptability, communication, barriers to use, broadening the circle of care, and tool limitations. Participants found the tool helpful for preparation, planning, and providing care, but disagreed on its community availability. Personalized risk estimates were valued for facilitating early goals of care conversations and normalizing discussions about death. However, concerns were raised about the tool's interpretation for individuals with different language, cultural, or educational backgrounds.

Conclusions

While electronic risk calculators were found to be acceptable, balancing autonomy with varying preferences for receiving the information and potential need for support is crucial.

Innovation

Providing patient-oriented life-expectancy estimates can enhance decisional capacity and facilitate shared decision-making between patients, their families, and healthcare professionals. Further research is needed to explore effective communication of personalized risk tools and additional benefits, harms, and barriers to implementation.

本研究旨在评估使用电子风险计算器预测和传达社区老年人死亡风险的可接受性、价值和感知障碍。方法对 16 名具有临终病人或家属护理经验的参与者进行了一次焦点小组讨论和八次访谈。讨论以死亡风险工具原型为基础。结果出现了五个主题：可接受性、沟通、使用障碍、扩大护理范围和工具局限性。参与者认为该工具有助于准备、计划和提供护理，但对其社区可用性存在分歧。个性化的风险估计对于促进早期护理目标对话和使死亡讨论正常化很有价值。创新提供以患者为导向的预期寿命估计值可以提高决策能力，促进患者、家属和医护人员共同决策。需要开展进一步的研究，探索个性化风险工具的有效沟通方式以及其他益处、危害和实施障碍。

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引用次数: 0

Development of an online tool to support financial and legal planning in dementia 开发支持痴呆症患者财务和法律规划的在线工具

PEC innovation

Pub Date : 2024-06-21 DOI: 10.1016/j.pecinn.2024.100312

Irene Tessaro , Sarah M. Hooper , Denise Watt , David Menestres , David Farrell

Objective

To develop, assess, and refine an online educational tool, Plan for Clarity, to support financial and legal planning in dementia.

Methods

A Delphi mixed-method study with three rounds of anonymous review by lay and professional stakeholders was designed to reach consensus about the content of the online tool and explore the socio-cultural and behavioral factors that could affect access and use.

Results

Consensus showed that the online tool covered key information, knowledge, and communication skills for financial and legal planning. Study themes: 1) the online tool had to be easy to navigate with relevant, easily understood information; 2) people with early signs of memory difficulties would be able to use the tool; 3) a referral from a trusted source is a primary way to facilitate access and use of the tool; and 4) discussions about financial and legal issues should be held early, ahead of barriers that can block discussion.

Conclusion

These data suggest this online tool is relevant and feasible for dementia care and support as well as aging more generally.

Innovation

Plan for Clarity is innovative as an evidence and theory-driven online education tool to address financial and legal planning for dementia care, particularly among underserved older adults.

方法设计了一项德尔菲混合方法研究，由非专业人士和专业利益相关者进行三轮匿名评审，以就在线工具的内容达成共识，并探索可能影响获取和使用的社会文化和行为因素。结果共识显示，在线工具涵盖了财务和法律规划的关键信息、知识和沟通技巧。研究主题：1）在线工具必须易于浏览，并提供相关的、易于理解的信息；2）有早期记忆障碍迹象的人能够使用该工具；3）可信来源的转介是促进获取和使用该工具的主要方式；以及 4）应尽早就财务和法律问题进行讨论，以消除可能阻碍讨论的障碍。创新性 "清晰计划 "作为一种以证据和理论为导向的在线教育工具，在解决痴呆症护理的财务和法律规划问题上具有创新性，尤其是在服务不足的老年人中。

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引用次数: 0

Prioritising Key Concepts for informed health choices in cancer: An evidence-based online educational programme 癌症知情健康选择的优先关键概念：循证在线教育计划

PEC innovation

Pub Date : 2024-06-20 DOI: 10.1016/j.pecinn.2024.100311

Mengqi Li , Declan Devane , Claire Beecher , Maura Dowling , Austin G. Duffy , Caitriona Duggan , David Robert Grimes , Avril Kennan , Claire Kilty , Allen Nsangi , Andrew D. Oxman , Derek C. Stewart , Elaine Toomey , Marie Tierney

Objective

The overabundance of health misinformation has undermined people's capacity to make evidence-based, informed choices about their health. Using the Informed Health Choices (IHC) Key Concepts (KCs), we are developing a two-stage education programme, Informed Health Choices-Cancer (IHC-C), to provide those impacted by cancer with the knowledge and skills necessary to think critically about the reliability of health information and claims and make well-informed choices. Stage 1 seeks to prioritise the most relevant Key Concepts.

Methods

A project group and a patient and carer participation group completed a two-round prioritisation process. The process involved disseminating pre-reading materials, training sessions, and a structured judgement form to evaluate concepts for inclusion. Data from each round were analysed to reach a consensus on the concepts to include.

Results

Fourteen participants were recruited and completed the first-round prioritisation. Fifteen participants undertook the second-round prioritisation. Nine Key Concepts were selected for the programme across five training sessions and two consensus meetings.

Conclusion

The prioritised concepts identified represent the most pertinent aspects of cancer-related information for those impacted by the disease. By incorporating these concepts into educational materials and communication strategies, healthcare providers and organisations can potentially help cancer patients, survivors, and their loved ones to recognise and combat cancer-related misinformation more effectively.

Innovation

This study introduces a participatory prioritisation process, which integrates the expertise of healthcare professionals with the insights of patients and carers, thereby enhancing the programme's relevance and applicability.

目标过多的健康误导信息削弱了人们对自己的健康做出以证据为基础的明智选择的能力。利用 "知情的健康选择"（IHC）关键概念（KCs），我们正在开发一项分为两个阶段的教育计划--"知情的健康选择-癌症"（IHC-C），为受癌症影响的人群提供必要的知识和技能，帮助他们批判性地思考健康信息和说法的可靠性，并做出明智的选择。方法一个项目小组和一个患者及护理者参与小组完成了两轮优先排序过程。该过程包括分发预读材料、培训课程和结构化判断表，以评估纳入的概念。结果招募了 14 名参与者并完成了第一轮的优先排序。15 名参与者进行了第二轮优先排序。通过五次培训课程和两次共识会议，为该计划选出了九个关键概念。通过将这些概念纳入教育材料和沟通策略中，医疗保健提供者和组织有可能帮助癌症患者、幸存者及其亲人更有效地识别和应对与癌症相关的错误信息。

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引用次数: 0

Associations between physicians' SDM behaviour and participation of older patients and family members in triadic decision-making: An observational study 医生的 SDM 行为与老年患者和家属参与三方决策之间的关系：观察研究

PEC innovation

Pub Date : 2024-06-19 DOI: 10.1016/j.pecinn.2024.100306

Bea L. Dijkman , Marie Louise Luttik , Wolter Paans , Ellen M. Driever , Hanneke van der Wal-Huisman , Paul L.P. Brand , Barbara.L. van Leeuwen

Background

Medical consultations with older patients often include triadic conversations and decision-making processes involving physicians, patients, and family members. The presence of family members may change the communication dynamics and therefore increase the complexity of the consultation and decision-making process.

Objective

This study explored associations between physicians' shared decision-making (SDM) behaviour and patients' and family members' participation in the decision-making process.

Methods

Using an observational design, we analysed 95 recorded consultations between medical specialists, patients aged ≥65 years, and accompanying family members at a Dutch hospital. The OPTION^MCC was used to assess the physicians' SDM behaviour and patients' and family members' levels of involvement in SDM.

Results

We found a strong positive correlation between physicians' behaviour and patients' and family members' participation in SDM (0.68 and 0.64, respectively, p < .01). Family members were more involved in SDM for patients aged 80 and older.

Conclusion

While not asserting causation, our study suggests physicians potentially play a facilitating role in shaping the SDM process together with proactive contributions from patients and family members.

Innovation

The results offer new insights into triadic SDM and provide suggestions for refining the OPTION^MCC. Further research is recommended into participants' mutual directional influences in triadic SDM.

背景老年患者的医疗咨询通常包括涉及医生、患者和家属的三方对话和决策过程。本研究探讨了医生的共同决策（SDM）行为与患者和家属参与决策过程之间的关系。方法我们采用观察法设计，分析了荷兰一家医院的 95 份医疗专家、年龄≥65 岁的患者和陪同家属之间的会诊记录。结果我们发现，医生的行为与患者和家属参与 SDM 的程度之间存在很强的正相关性（分别为 0.68 和 0.64，p <.01）。结论虽然不能断言因果关系，但我们的研究表明，医生在 SDM 过程中可能起到促进作用，患者和家属也会积极主动地参与其中。建议进一步研究参与者在三方 SDM 中的相互定向影响。

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引用次数: 0