'They leave at least believing they had a part in the discussion': understanding decision aid use and patient-clinician decision-making through qualitative research.
'They leave at least believing they had a part in the discussion': understanding decision aid use and patient-clinician decision-making through qualitative research.
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DOI：
10.1016/j.pec.2013.03.013
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发表时间：
2013-10
影响因子：
3.5
通讯作者：
Montori VM
中科院分区：
文献类型：
--
作者：
Tiedje K;Shippee ND;Johnson AM;Flynn PM;Finnie DM;Liesinger JT;May CR;Olson ME;Ridgeway JL;Shah ND;Yawn BP;Montori VM
本研究探讨了如何将设计用于临床咨询的抗高血糖药物和他汀类药物的患者决策辅助（DA）嵌入实践中，研究患者和临床医生如何理解和体验DA在初级保健访视中。我们对患者（n = 22）和初级保健临床医生（n = 19）进行了半结构化的深入访谈，并对咨询进行了录像（n = 44）。两名研究人员对所有记录进行了编码。在扎根理论指导下的归纳分析导致了主题的识别。视频和访谈数据进行了比较，并按主题组织。在咨询过程中使用的DA成为灵活的人工制品，被纳入临床医生（专家，权威人物，说服者，顾问）和患者（医疗保健的驱动程序，学习者，合作伙伴）的现有决策角色。DA被应用于不同的决策步骤（审议，谈判，说服，案例评估），并引入到现有的知识背景（参与者的识字有关的共同决策（SDM）和DA）。在磋商期间灵活使用指定用途安排，即使在“可持续发展机制”没有实现的情况下，也有效地为讨论提供了空间。DA可以在任何决策模型中使用。可能需要对临床医生进行DA使用和SDM实践方面的培训，以促进DA的实施，并促进更理想的决策共享形式。
This study explores how patient decision aids (DAs) for antihyperglycemic agents and statins, designed for use during clinical consultations, are embedded into practice, examining how patients and clinicians understand and experience DAs in primary care visits. We conducted semistructured in-depth interviews with patients (n = 22) and primary care clinicians (n = 19), and videorecorded consultations (n = 44). Two researchers coded all transcripts. Inductive analyses guided by grounded theory led to the identification of themes. Video and interview data were compared and organized by themes. DAs used during consultations became flexible artifacts, incorporated into existing decision making roles for clinicians (experts, authority figures, persuaders, advisors) and patients (drivers of healthcare, learners, partners). DAs were applied to different decision making steps (deliberation, bargaining, convincing, case assessment), and introduced into an existing knowledge context (participants’ literacy regarding shared decision-making (SDM) and DAs). DAs’ flexible use during consultations effectively provided space for discussion, even when SDM was not achieved. DAs can be used within any decision-making model. Clinician training in DA use and SDM practice may be needed to facilitate DA implementation and promote more ideal-type forms of sharing in decision making.
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影响因子：
2.1
作者：
Moulton, Benjamin;King, Jaime S.
通讯作者：
King, Jaime S.
影响因子：
5.7
作者：
Morgan, MW;Deber, RB;Detsky, AS
通讯作者：
Detsky, AS
影响因子：
16.2
作者：
Bohlen, Krista;Scoville, Elizabeth;Montori, Victor M.
通讯作者：
Montori, Victor M.
影响因子：
5.4
作者：
Charles, C;Gafni, A;Whelan, T
通讯作者：
Whelan, T
影响因子：
5.9
作者：
Montori, Victor M.;Shah, Nilay D.;Wermers, Robert A.
通讯作者：
Wermers, Robert A.