对中至重度哮喘患者自主性的了解
2022/03/17
摘要
背景：自主性指的是患者做出医疗决策的能力。自主权源于对疾病状态的理解。当照顾不同人群时，医学伦理学，尤其是自主性原则，在医疗保健服务中发挥着重要作用。
目的：本研究目的是识别影响自主性的患者特征。
方法：在一项为期1年的随机临床试验开始时，共295名中至重度哮喘患者完成了2项调查。将NAC 2问卷（一项用于评估哮喘患者自我管理和健康知识的问卷）和吸入性皮质激素知识问卷结合，组成一项共含有21个问题的自主性评估，得分范围为10到105分。根据患者基线特征预测的自主性得分进行线性回归。
结果：比较发现，以西班牙语为主要语言的患者（P=0.01）、糖尿病患者（P=0.01）和有抑郁症状的患者（P=0.03）的基线自主性得分分别为-11.4分（95%CI，-20.5 ~ -2.3）、-4.8分（95%CI，-8.3 ~ -1.3）和-3.1分（95%CI，-5.9 ~ -0.3），差异具有统计学意义。与非西班牙裔的黑人参与者相比，非西班牙裔的白人参与者平均有8.2分（95% CI，4.5 ~ 12.0）的自主性得分（通过Bonferroni调整后 P < .01）。功能性健康素养较高的患者自主性得分较高（系数=0.24；95%CI，0.1 ~ 0.4；P < .01）。
结论：自主性与合并症、人口统计学和文化程度有关。这些结果可能反映了患者遇到的社会、教育和经济机会方面的差异。需要进一步调查以评估和了解社会经济因素和教育因素是如何影响自主性。通过确定基于基线病人特征的自主性差异，该项目可成为调整当前及开发新的治疗指南和干预措施，进而提高病人自主性的第一步。
Understanding Autonomy in Patients with Moderate to Severe Asthma.
Timothy M Buckey, Knashawn H Morales, Andrea J Apter.
Abstract
BACKGROUND:Autonomy is the ability of patients to make informed medical decisions. Autonomy is rooted in disease state understanding. Medical ethics, especially the principle of autonomy, plays an important role in health care delivery when caring for diverse populations.
OBJECTIVE:To identify patient characteristics that influence autonomy.
METHODS:A total of 295 adults with moderate to severe asthma completed 2 surveys at the beginning of a 1-year randomized clinical trial. The Navigating Ability 2 and Inhaled Corticosteroids Knowledge questionnaires were combined to create a 21-question assessment of autonomy with possible scores ranging from 10 to 105. Linear regression was performed on the derived autonomy score predicted by patient baseline characteristics.
RESULTS:Comparison revealed statistically significant differences in baseline autonomy scores in patients who reported Spanish as their primary language (P = .01), patients with diabetes (P = .01), and those with depressive symptoms (P = .03) at -11.4 (95% CI, -20.5 to -2.3), -4.8 (95% CI, -8.3 to -1.3), and -3.1 (95% CI, -5.9 to -0.3) points, respectively. Non-Hispanic White participants on average were found to have 8.2 (95% CI, 4.5 to 12.0) points higher autonomy scores compared with non-Hispanic Black participants (Bonferroni-adjusted P < .01). Patients with higher functional health literacy had higher autonomy scores (coefficient = 0.24; 95% CI, 0.1 to 0.4; P < .01).
CONCLUSIONS:Autonomy is associated with comorbidities, demographics, and literacy. These results may reflect differences in social, educational, and economic opportunities encountered by patients. Further investigation is needed to assess and understand how socioeconomic and educational factors influence autonomy. By identifying differences in autonomy based on baseline patient characteristics, this project serves as an initial step in adjusting current and developing new treatment guidelines and interventions to improve patient autonomy.
背景：自主性指的是患者做出医疗决策的能力。自主权源于对疾病状态的理解。当照顾不同人群时，医学伦理学，尤其是自主性原则，在医疗保健服务中发挥着重要作用。
目的：本研究目的是识别影响自主性的患者特征。
方法：在一项为期1年的随机临床试验开始时，共295名中至重度哮喘患者完成了2项调查。将NAC 2问卷（一项用于评估哮喘患者自我管理和健康知识的问卷）和吸入性皮质激素知识问卷结合，组成一项共含有21个问题的自主性评估，得分范围为10到105分。根据患者基线特征预测的自主性得分进行线性回归。
结果：比较发现，以西班牙语为主要语言的患者（P=0.01）、糖尿病患者（P=0.01）和有抑郁症状的患者（P=0.03）的基线自主性得分分别为-11.4分（95%CI，-20.5 ~ -2.3）、-4.8分（95%CI，-8.3 ~ -1.3）和-3.1分（95%CI，-5.9 ~ -0.3），差异具有统计学意义。与非西班牙裔的黑人参与者相比，非西班牙裔的白人参与者平均有8.2分（95% CI，4.5 ~ 12.0）的自主性得分（通过Bonferroni调整后 P < .01）。功能性健康素养较高的患者自主性得分较高（系数=0.24；95%CI，0.1 ~ 0.4；P < .01）。
结论：自主性与合并症、人口统计学和文化程度有关。这些结果可能反映了患者遇到的社会、教育和经济机会方面的差异。需要进一步调查以评估和了解社会经济因素和教育因素是如何影响自主性。通过确定基于基线病人特征的自主性差异，该项目可成为调整当前及开发新的治疗指南和干预措施，进而提高病人自主性的第一步。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2022 Feb;10(2):525-533. doi: 10.1016/j.jaip.2021.10.068. Epub 2021 Nov 14.)
(J Allergy Clin Immunol Pract. 2022 Feb;10(2):525-533. doi: 10.1016/j.jaip.2021.10.068. Epub 2021 Nov 14.)
Understanding Autonomy in Patients with Moderate to Severe Asthma.
Timothy M Buckey, Knashawn H Morales, Andrea J Apter.
Abstract
BACKGROUND:Autonomy is the ability of patients to make informed medical decisions. Autonomy is rooted in disease state understanding. Medical ethics, especially the principle of autonomy, plays an important role in health care delivery when caring for diverse populations.
OBJECTIVE:To identify patient characteristics that influence autonomy.
METHODS:A total of 295 adults with moderate to severe asthma completed 2 surveys at the beginning of a 1-year randomized clinical trial. The Navigating Ability 2 and Inhaled Corticosteroids Knowledge questionnaires were combined to create a 21-question assessment of autonomy with possible scores ranging from 10 to 105. Linear regression was performed on the derived autonomy score predicted by patient baseline characteristics.
RESULTS:Comparison revealed statistically significant differences in baseline autonomy scores in patients who reported Spanish as their primary language (P = .01), patients with diabetes (P = .01), and those with depressive symptoms (P = .03) at -11.4 (95% CI, -20.5 to -2.3), -4.8 (95% CI, -8.3 to -1.3), and -3.1 (95% CI, -5.9 to -0.3) points, respectively. Non-Hispanic White participants on average were found to have 8.2 (95% CI, 4.5 to 12.0) points higher autonomy scores compared with non-Hispanic Black participants (Bonferroni-adjusted P < .01). Patients with higher functional health literacy had higher autonomy scores (coefficient = 0.24; 95% CI, 0.1 to 0.4; P < .01).
CONCLUSIONS:Autonomy is associated with comorbidities, demographics, and literacy. These results may reflect differences in social, educational, and economic opportunities encountered by patients. Further investigation is needed to assess and understand how socioeconomic and educational factors influence autonomy. By identifying differences in autonomy based on baseline patient characteristics, this project serves as an initial step in adjusting current and developing new treatment guidelines and interventions to improve patient autonomy.
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社会风险干预和小儿哮喘的卫生服务利用: 系统评价和荟萃分析
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终身体质指数轨迹对成人哮喘发病率和持续性的影响
