On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid
On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid
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DOI：
10.1111/jep.12665
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发表时间：
2018-02-01
影响因子：
2.4
通讯作者：
Wood, Fiona
中科院分区：
文献类型：
--
作者：
Elwyn, Glyn;Rasmussen, Julie;Wood, Fiona
在临床接触中使用RationalTools向患者说明治疗选择的风险和益处，已经显示可以增加共同决策。然而，关于临床医生如何看待这些工具，以及临床医生如何看待患者对其使用的反应，我们没有很好的信息。我们的目的是检查临床医生对可能和实际使用的工具的看法，这些工具旨在支持患者和临床医生合作和审议治疗方案，即选项网格决策辅助工具。方法：我们对选择性网格决策辅助治疗膝关节骨关节炎试验干预阶段的定性访谈进行了专题分析。在6名临床医生使用该工具之前对他们进行了访谈，在临床医生对6名患者使用该工具后再次进行了访谈。结果在第一次访谈中，临床医生表示担心该工具会导致就诊时间增加，患者对参与决策的抵制，以及潜在的信息过载。在第二次面试中，经过最低限度的培训，临床医生报告说，该工具已经改变了他们通常的沟通方式，并且将其整合到实践中是普遍可接受和有益的。讨论与结论在体验了Option grid的使用后，临床医生更愿意在与患者的临床接触中使用该工具。如何最好地向临床医生介绍选择网格并将其应用于实践，需要仔细考虑上下文、工作流程和临床途径。
RationalTools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use.ObjectiveOur aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids.MethodWe conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients.ResultsIn the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice.Discussion and ConclusionsAfter experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways.