Development of a shared decision making coding system for analysis of patient-healthcare provider encounters
Development of a shared decision making coding system for analysis of patient-healthcare provider encounters
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DOI：
10.1016/j.pec.2012.06.011
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发表时间：
2012-09-01
影响因子：
3.5
通讯作者：
Williams, Adam R.
中科院分区：
文献类型：
--
作者：
Clayman, Marla L.;Makoul, Gregory;Williams, Adam R.
目的：描述一个方案的发展和完善，共享决策（DEEP-SDM）的基本要素和参与者的细节，用于编码共享决策（SDM），同时报告转移性乳腺癌患者样本的决策特征。方法：修改循证患者选择工具，以反映Makoul和Clayman的SDM综合模型。对20名妇女在怀疑疾病进展后第一次与肿瘤医生见面时的录像进行编码。采用Noldus Observer XT v.8视频编码软件平台进行编码。结果：样本包含80个决策（范围：1-11），分为150个决策段。大多数决定是由医生主导的，尽管患者和医生发起的决策对话数量相似。结论：DEEP-SDM有助于分析转移性乳腺癌患者与其内科肿瘤学家之间的接触内容。尽管决策制定具有断裂的性质，但是确定决策点并对共享决策制定的每个基本元素进行编码是可能的。进一步的工作应该包括将DEEP-SDM应用于非癌症遭遇。实践意义：更好地理解在医疗遭遇中如何展开决策可以帮助告知SDM与患者报告结果的关系。2012爱思唯尔爱尔兰有限公司版权所有。
Objectives: To describe the development and refinement of a scheme, detail of essential elements and participants in shared decision making (DEEP-SDM), for coding shared decision making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer.Methods: The evidence-based patient choice instrument was modified to reflect Makoul and Clayman's integrative model of SDM. Coding was conducted on video recordings of 20 women at the first visit with their medical oncologists after suspicion of disease progression. Noldus Observer XT v.8, a video coding software platform, was used for coding.Results: The sample contained 80 decisions (range: 1-11), divided into 150 decision making segments. Most decisions were physician-led, although patients and physicians initiated similar numbers of decision-making conversations.Conclusion: DEEP-SDM facilitates content analysis of encounters between women, with metastatic breast cancer and their medical oncologists. Despite the fractured nature of decision making, it is possible to identify decision points and to code each of the essential elements of shared decision making. Further work should include application of DEEP-SDM to non-cancer encounters.Practice implications: A better understanding of how decisions unfold in the medical encounter can help inform the relationship of SDM to patient-reported outcomes. (C) 2012 Elsevier Ireland Ltd. All rights reserved.