Does Shared Decision Making Actually Occur in the Emergency Department? Looking at It from the Patients' Perspective.
Does Shared Decision Making Actually Occur in the Emergency Department? Looking at It from the Patients' Perspective.
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DOI：
10.1111/acem.13850
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发表时间：
2019-12
期刊：
影响因子：
--
通讯作者：
Kanzaria HK
中科院分区：
文献类型：
--
作者：
Schoenfeld EM;Probst MA;Quigley DD;St Marie P;Nayyar N;Sabbagh SH;Beckford T;Kanzaria HK
我们试图从患者的角度评估急诊科（艾德）共享决策（SDM）的频率、内容和质量。利用一个横截面，多站点的方法，我们管理的仪器，包括两个经过验证的SDM评估工具-CollaboRATE和SDM-Q-9-和一个新开发的工具，以样本的艾德患者。我们的主要结果是SDM在临床遭遇中的发生率，如参与者在CollaboRATE测量中给出的“顶盒”分数所定义的，以及患者识别其SDM对话主题的能力。次要结果包括SDM对话的内容，由患者判断，以及患者是否能够完成仪器中包含的两个验证量表中的每一个。排除后，来自两个地点的285名参与者完成了复合文书。不到一半的人被认为是女性（47%）或白色（47%）。大约一半的人给出了最高分（即，指示最佳SDM）在CollaboRATE量表上（49%）。不到一半的参与者能够表明他们参与的决定（44%），尽管那些确实这样做的人在这样的对话中得分很高（通过SDM-Q-9工具，73/100）。最常见的决定是入院与出院（19%），药物选择（17%）和后续护理（15%）的选择。不到一半的艾德患者报告他们参与了SDM。使用SDM的最常见决定是在艾德周围处置（入院vs.出院）。当使用SDM时，患者普遍对讨论评价很高。
We sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients’ perspectives. Utilizing a cross-sectional, multisite approach, we administered an instrument, consisting of two validated SDM assessment tools—the CollaboRATE and the SDM-Q-9—and one newly developed tool to a sample of ED patients. Our primary outcome was the occurrence of SDM in the clinical encounter, as defined by participants giving “top-box” scores on the CollaboRATE measure, and the ability of patients to identify the topic of their SDM conversation. Secondary outcomes included the content of the SDM conversations, as judged by patients, and whether patients were able to complete each of the two validated scales included in the instrument. After exclusions, 285 participants from two sites completed the composite instrument. Just under half identified as female (47%) or as white (47%). Roughly half gave top-box scores (i.e., indicating optimal SDM) on the CollaboRATE scale (49%). Less than half of the participants were able to indicate a decision they were involved in (44%), although those who did gave high scores for such conversations (73/100 via the SDM-Q-9 tool). The most frequently identified decisions discussed were admission versus discharge (19%), medication options (17%), and options for follow-up care (15%). Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.
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