Study On The Development Of A Therapeutic Decision Aid For Patients With Refractory Allergic Rhinitis

Objective:1.By means of qualitative research,the treatment decision-making process and decision-making experience of patients with refractory allergic rhinitis were deeply understood,the decision-making needs of patients were understood,and the factors affecting the treatment decision-making of patients were analyzed,providing reference for the development of personalized decision-making aid tools.2.In order to provide scientific basis for the formulation of decision aid tools,Delphi expert consultation method was used to construct treatment decision aids for patients with refractory allergic rhinitis based on Ottawa decision support framework.3.Compile the constructed decision aid content into a convenient decision aid tools,provide structured guidance and support for patients’ treatment decision-making,and reduce the decision-making dilemma of patients.Methods:1.Through the phenomenological method,patients with refractory allergic rhinitis who were admitted to the third-class a hospital in Shanxi Province from April to October2021 were selected for semi-structured in-depth interviews according to the maximum difference sampling strategy.Data were analyzed and themes were extracted by colaizzi7-step analysis method.2.Based on the Ottawa decision support framework as the theoretical basis,the Delphi expert consultation method was adopted to form the first draft of the decision support content combined with the existing research basis and literature review.The expert consultation questionnaire was developed,and 15 experts were consulted for two rounds to form the final decision support content for the treatment of refractory allergic rhinitis patients.3.According to the previously constructed aid content of treatment decision for patients with refractory allergic rhinitis,the aid tool for treatment decision for patients with refractory allergic rhinitis was developed.Results:1.In this study,12 patients with refractory allergic rhinitis were interviewed about their decision-making process.The final analysis yielded three themes and nine sub-themes.These were decision-making experience(fears,procrastinating,positive face),decision-making requirements(decision-making information needs,decision support needs,decision aid needs),the factors influencing decision-making(personal factors,social factors,situational factors).2.The decision-making aid content formed through expert consultation in this study includes 3 first-level items,6 second-level items and 33 third-level items.Three first-level items are decision needs,decision support and decision results,and six second-level items are evaluation of decision needs,providing disease knowledge information,providing surgical/non-surgical information,providing decision support,promoting decision making,and evaluating decision results.In this study,a total of 15 experts completed two rounds of Delphi expert consultation.The effective questionnaire recovery rate of the two rounds of expert consultation was 88% and 100% respectively,and the proportion of experts who put forward opinions was 60.0% and 13.3%respectively.The expert authority coefficient was 0.877;In the second round of expert consultation,the coordination coefficients of first-level,second-level and third-level items were 0.533,0.395,0.210(P < 0.001),and the coefficient of variation was 0~0.205.In the second round of expert consultation,the mean value of items at all levels was 3.93~5.00,the standard deviation was 0~0.88,and the full score ratio was 26.6%~100%.3.According to the results of the previous study,a 14-page treatment decision-making aid tool for patients with refractory allergic rhinitis was finally formed,providing systematic decision-making guidance to patients through the form of manual.Conclusion:1.The results of qualitative study showed that patients with refractory allergic rhinitis had negative emotions,lack of treatment information,and the treatment decision was affected by many factors,with high demand for decision-making aid.Therefore,medical staff should pay attention to patients’ negative emotions,provide psychological intervention and professional information support,develop personalized decision-making aids,promote the implementation of shared decision-making,and improve patients’ decision satisfaction.2.In this study,the aid content of treatment decision for patients with refractory allergic rhinitis was constructed,and the consultation experts were highly representative.The research method was scientific and rigorous,and the consultation results were reliable,which could provide scientific basis for the compilation of decision-making aid tools.3.The decision-making aid tool for patients with refractory allergic rhinitis prepared in this study is presented in the form of a manual with detailed content,strong operability and easy to use,which can provide convenience for future clinical application.