Shared Decision Making in Patients With Suspected Uncomplicated Ureterolithiasis: A Decision Aid Development Study.
Shared Decision Making in Patients With Suspected Uncomplicated Ureterolithiasis: A Decision Aid Development Study.
复制标题
DOI：
10.1111/acem.13917
复制
发表时间：
2020-07
期刊：
影响因子：
--
通讯作者：
Hess EP
中科院分区：
文献类型：
--
作者：
Schoenfeld EM;Houghton C;Patel PM;Merwin LW;Poronsky KP;Caroll AL;Sánchez Santana C;Breslin M;Scales CD;Lindenauer PK;Mazor KM;Hess EP
目的是开发一种决策辅助 (DA)，以促进关于是否对疑似无并发症输尿管结石的急诊科 (ED) 患者进行计算机断层扫描 (CT) 成像的共同决策 (SDM)。我们使用基于证据的发展议程开发方法，包括定性方法和利益相关者迭代参与，来开发和完善发展议程。在渥太华决策支持框架、国际患者决策援助标准 (IPDAS) 和由利益相关者组成的指导委员会的指导下，我们对患者、社区成员、急诊临床医生和其他利益相关者进行了访谈和焦点小组调查。我们使用迭代过程对文字记录进行编码并确定主题。我们对 DA 进行了 Beta 测试，患者和临床医生两人实时面临决策。从 2018 年 8 月到 2019 年 8 月，我们邀请 102 名参与者参与了 DA 的设计和迭代完善，重点关注疑似输尿管结石患者的诊断选择。 46 人是急诊科患者、社区成员或输尿管结石患者，其余是急诊临床医生（医生、住院医师、高级执业医师）、研究人员、泌尿科医生、护士或其他医生。患者和临床医生确定了几个关键的决策需求，包括了解准确性、不确定性、辐射暴露/癌症风险以及明确的返回预防措施。患者和社区成员确定了 SDM 的促进因素，例如体征和症状清单。许多利益相关者，包括患者和急诊临床医生，都表达了强烈的支持 CT 的偏见。开发了一份六页的 DA，经过迭代完善并进行了 beta 测试。通过利益相关者参与和定性调查，我们开发了一个基于证据的 DA，以促进围绕疑似无并发症输尿管结石患者 CT 扫描使用问题的 SDM。未来的研究将测试 DA 在促进 SDM 方面的功效。
The objective was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis. We used evidence-based DA development methods, including qualitative methods and iterative stakeholder engagement, to develop and refine a DA. Guided by the Ottawa Decision Support Framework, International Patient Decision Aid Standards (IPDAS), and a steering committee made up of stakeholders, we conducted interviews and focus groups with a purposive sample of patients, community members, emergency clinicians, and other stakeholders. We used an iterative process to code the transcripts and identify themes. We beta-tested the DA with patient–clinician dyads facing the decision in real time. From August 2018 to August 2019, we engaged 102 participants in the design and iterative refinement of a DA focused on diagnostic options for patients with suspected ureterolithiasis. Forty-six were ED patients, community members, or patients with ureterolithiasis, and the remaining were emergency clinicians (doctors, residents, advanced practitioners), researchers, urologists, nurses, or other physicians. Patients and clinicians identified several key decisional needs including an understanding of accuracy, uncertainty, radiation exposure/cancer risk, and clear return precautions. Patients and community members identified facilitators to SDM, such as a checklist of signs and symptoms. Many stakeholders, including both patients and ED clinicians, expressed a strong pro-CT bias. A six-page DA was developed, iteratively refined, and beta-tested. Using stakeholder engagement and qualitative inquiry, we developed an evidence-based DA to facilitate SDM around the question of CT scan utilization in patients with suspected uncomplicated ureterolithiasis. Future research will test the efficacy of the DA in facilitating SDM.
登录
查看更多内容
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
4.4
作者：
Probst, Marc A.;Kanzaria, Hemal K.;Richardson, Lynne D.
通讯作者：
Richardson, Lynne D.
影响因子：
6.2
作者：
Probst, Marc A.;Kanzaria, Hemal K.;Hess, Erik P.
通讯作者：
Hess, Erik P.
DOI：
10.1111/acem.13373
发表时间：
2018-04
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
--
作者：
Probst MA;Hess EP;Breslin M;Frosch DL;Sun BC;Langan MN;Richardson LD
通讯作者：
Richardson LD
DOI：
10.1136/bmj.g2191
发表时间：
2014-03-26
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore CL;Bomann S;Daniels B;Luty S;Molinaro A;Singh D;Gross CP
通讯作者：
Gross CP